Healthcare Provider Details

I. General information

NPI: 1497068829
Provider Name (Legal Business Name): JACQUELINE ERIN DONOVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 THE CITY DRIVE SUITE 2150
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 9774
FOUNTAIN VALLEY CA
92728-9774
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5501
  • Fax:
Mailing address:
  • Phone: 407-921-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number279116
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number148425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: