Healthcare Provider Details

I. General information

NPI: 1821901513
Provider Name (Legal Business Name): JON KELIIPULEOLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26231 DARDANELLE CT
MORENO VALLEY CA
92555-2465
US

IV. Provider business mailing address

26231 DARDANELLE CT
MORENO VALLEY CA
92555-2465
US

V. Phone/Fax

Practice location:
  • Phone: 805-264-3576
  • Fax:
Mailing address:
  • Phone: 805-264-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number10206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: