Healthcare Provider Details

I. General information

NPI: 1174419014
Provider Name (Legal Business Name): EMILY K JAEN BSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 ALVARADO RD
LA MESA CA
91942-8901
US

IV. Provider business mailing address

1651 VAQUERO GLN
ESCONDIDO CA
92026-1647
US

V. Phone/Fax

Practice location:
  • Phone: 619-439-7840
  • Fax:
Mailing address:
  • Phone: 858-471-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036328
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number675884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: