Healthcare Provider Details

I. General information

NPI: 1255709028
Provider Name (Legal Business Name): JENNIFER BOURAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SIENA
LAGUNA NIGUEL CA
92677-8631
US

IV. Provider business mailing address

PO BOX 4503
MISSION VIEJO CA
92690-4503
US

V. Phone/Fax

Practice location:
  • Phone: 949-424-2955
  • Fax:
Mailing address:
  • Phone: 949-424-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: