Healthcare Provider Details

I. General information

NPI: 1811860323
Provider Name (Legal Business Name): JASON MEOLA DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30300 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-1304
US

IV. Provider business mailing address

31351 RANCHO VIEJO RD STE 201
SAN JUAN CAPISTRANO CA
92675-1858
US

V. Phone/Fax

Practice location:
  • Phone: 949-240-2272
  • Fax:
Mailing address:
  • Phone: 949-240-2030
  • Fax: 949-429-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: