Healthcare Provider Details

I. General information

NPI: 1477357713
Provider Name (Legal Business Name): JACQUELYNNE KRISTY ROBLES SALAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 IRVINE CENTER DR
IRVINE CA
92618-2117
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax: 858-795-1195
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-795-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: