Healthcare Provider Details

I. General information

NPI: 1710589809
Provider Name (Legal Business Name): JAQUELINE RODRIGUEZ-TAPIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CALLE AMANECER
SAN CLEMENTE CA
92673-6214
US

IV. Provider business mailing address

28692 AVENIDA DEL CABALLO
LAGUNA NIGUEL CA
92677-4533
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-5100
  • Fax: 949-366-5665
Mailing address:
  • Phone: 949-899-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: