Healthcare Provider Details

I. General information

NPI: 1255261046
Provider Name (Legal Business Name): JAYLIN SAMARA HELMY DE LA ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41769 11TH ST W STE A
PALMDALE CA
93551-1418
US

IV. Provider business mailing address

43048 DARBY ST
LANCASTER CA
93535-5165
US

V. Phone/Fax

Practice location:
  • Phone: 661-585-6364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: