Healthcare Provider Details

I. General information

NPI: 1265847529
Provider Name (Legal Business Name): JACQUELINE DEATS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY DR
ORANGE CA
92866-1005
US

IV. Provider business mailing address

1 UNIVERSITY DR
ORANGE CA
92866-1005
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-6851
  • Fax: 714-744-7077
Mailing address:
  • Phone: 714-997-6851
  • Fax: 714-744-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: