Healthcare Provider Details

I. General information

NPI: 1750887477
Provider Name (Legal Business Name): LORISSA JENEFFER PRESCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MISSION AVE STE 230
OCEANSIDE CA
92058-7110
US

IV. Provider business mailing address

1701 MISSION AVE STE 230
OCEANSIDE CA
92058-7110
US

V. Phone/Fax

Practice location:
  • Phone: 760-712-3535
  • Fax:
Mailing address:
  • Phone: 760-295-9830
  • Fax: 760-439-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: