Healthcare Provider Details

I. General information

NPI: 1467247692
Provider Name (Legal Business Name): JAYCEE EDMISTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15635 ALTON PKWY STE 350
IRVINE CA
92618-7333
US

IV. Provider business mailing address

15635 ALTON PKWY STE 350
IRVINE CA
92618-7333
US

V. Phone/Fax

Practice location:
  • Phone: 949-528-6300
  • Fax:
Mailing address:
  • Phone: 949-528-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: