Healthcare Provider Details

I. General information

NPI: 1336055763
Provider Name (Legal Business Name): MS. JESCELYN A SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

IV. Provider business mailing address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

V. Phone/Fax

Practice location:
  • Phone: 909-894-7614
  • Fax: 909-894-7961
Mailing address:
  • Phone: 909-894-7614
  • Fax: 909-894-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number511880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: