Healthcare Provider Details

I. General information

NPI: 1508219718
Provider Name (Legal Business Name): JAQUOLIN ESKANDR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9041 MAGNOLIA AVE
RIVERSIDE CA
92503-3900
US

IV. Provider business mailing address

13741 ANDELE WAY
IRVINE CA
92620-3228
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-0004
  • Fax:
Mailing address:
  • Phone: 714-705-3195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95004518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: