Healthcare Provider Details

I. General information

NPI: 1093672651
Provider Name (Legal Business Name): JACKIE RAYGOZA DNP, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11262 CAMPUS ST
LOMA LINDA CA
92350-1727
US

IV. Provider business mailing address

8554 RAVILLER DR
DOWNEY CA
90240-3310
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95040128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: