Healthcare Provider Details

I. General information

NPI: 1285569160
Provider Name (Legal Business Name): JACOB DENOYER BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15615 POMERADO RD
POWAY CA
92064-2405
US

IV. Provider business mailing address

3275 5TH AVE APT 303
SAN DIEGO CA
92103-5742
US

V. Phone/Fax

Practice location:
  • Phone: 858-613-4000
  • Fax:
Mailing address:
  • Phone: 386-341-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: