Healthcare Provider Details

I. General information

NPI: 1295670925
Provider Name (Legal Business Name): MS. JAYLENE ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23046 AVENIDA DE LA CARLOTA STE 600
LAGUNA HILLS CA
92653-1537
US

IV. Provider business mailing address

22365 EL TORO RD STE 151
LAKE FOREST CA
92630-5053
US

V. Phone/Fax

Practice location:
  • Phone: 714-208-0590
  • Fax: 949-208-6072
Mailing address:
  • Phone: 714-208-0590
  • Fax: 949-208-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: