Healthcare Provider Details

I. General information

NPI: 1619831526
Provider Name (Legal Business Name): JENESA CARY CAZARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 S EL CAMINO REAL STE 102
OCEANSIDE CA
92054-6209
US

IV. Provider business mailing address

2122 S EL CAMINO REAL STE 102
OCEANSIDE CA
92054-6209
US

V. Phone/Fax

Practice location:
  • Phone: 760-290-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-URTHBY
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: