Healthcare Provider Details

I. General information

NPI: 1003727645
Provider Name (Legal Business Name): JENNIFER LYNN EALY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25125 MADISON AVE STE 105
MURRIETA CA
92562-8970
US

IV. Provider business mailing address

27150 SHADEL RD SPC 191
MENIFEE CA
92586-3314
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-7084
  • Fax:
Mailing address:
  • Phone: 909-824-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number242252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: