Healthcare Provider Details

I. General information

NPI: 1043063852
Provider Name (Legal Business Name): EDITH JAUREGUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11487 SAN FERNANDO RD
SAN FERNANDO CA
91340-3406
US

IV. Provider business mailing address

11487 SAN FERNANDO ROAD
SAN FERNANDO CA
91340
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax:
Mailing address:
  • Phone: 186-660-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: