Healthcare Provider Details

I. General information

NPI: 1225504939
Provider Name (Legal Business Name): JALISA SYLVESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27261 LAS RAMBLAS STE 220
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

27261 LAS RAMBLAS STE 220
MISSION VIEJO CA
92691-6468
US

V. Phone/Fax

Practice location:
  • Phone: 909-835-4800
  • Fax:
Mailing address:
  • Phone: 909-835-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number22540000X
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: