Healthcare Provider Details

I. General information

NPI: 1851238133
Provider Name (Legal Business Name): JORENE NICOLAS RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10965 PACIFIC POINT PL UNIT 4321
SAN DIEGO CA
92129-2297
US

IV. Provider business mailing address

10965 PACIFIC POINT PL UNIT 4321
SAN DIEGO CA
92129-2297
US

V. Phone/Fax

Practice location:
  • Phone: 858-888-9411
  • Fax:
Mailing address:
  • Phone: 858-888-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number25510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: