Healthcare Provider Details

I. General information

NPI: 1255268405
Provider Name (Legal Business Name): JOANNA C JAISWAL RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA JAISWAL DA ROSA

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

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

3030 MONARCH ST
SAN DIEGO CA
92123-3244
US

V. Phone/Fax

Practice location:
  • Phone: 619-831-3685
  • Fax:
Mailing address:
  • Phone: 619-831-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: