Healthcare Provider Details

I. General information

NPI: 1679497622
Provider Name (Legal Business Name): JACQUELINE GOLSCH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE GOLSCH RNFA

II. Dates (important events)

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

III. Provider practice location address

24451 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3689
US

IV. Provider business mailing address

2721 COPPER COIN
CRESTVIEW HILLS KY
41017-2278
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-4500
  • Fax:
Mailing address:
  • Phone: 859-393-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1133654
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number95389564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: