Healthcare Provider Details

I. General information

NPI: 1801026067
Provider Name (Legal Business Name): JAQUELINE POPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 E PALMDALE BLVD SUITE G
PALMDALE CA
93550-4881
US

IV. Provider business mailing address

44021 ANDALE AVE
LANCASTER CA
93535-4120
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-1595
  • Fax:
Mailing address:
  • Phone: 310-696-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: