Healthcare Provider Details

I. General information

NPI: 1144757626
Provider Name (Legal Business Name): JACLYN GELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 VISTA WAY # 130
OCEANSIDE CA
92054-5661
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-704-5630
  • Fax:
Mailing address:
  • Phone: 760-704-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A20568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: