Healthcare Provider Details

I. General information

NPI: 1942809009
Provider Name (Legal Business Name): JESSICA MICHELE CUEVAS ROSAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE STE G21
LONG BEACH CA
90804-2182
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE 300
IRVINE CA
92612-2417
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax:
Mailing address:
  • Phone: 714-545-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA58647
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number58647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: