Healthcare Provider Details

I. General information

NPI: 1578225074
Provider Name (Legal Business Name): JESLIN IUDA PREAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E PACIFIC COAST HWY STE 100
LONG BEACH CA
90804-3233
US

IV. Provider business mailing address

4500 E PACIFIC COAST HWY STE 100
LONG BEACH CA
90804-3233
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC10763
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC10763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: