Healthcare Provider Details

I. General information

NPI: 1275490047
Provider Name (Legal Business Name): JENNIFER MESISCA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PACIFICA STE 450
IRVINE CA
92618-3343
US

IV. Provider business mailing address

26135 CORDILLERA DR
MISSION VIEJO CA
92691-4015
US

V. Phone/Fax

Practice location:
  • Phone: 949-861-5583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86043231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: