Healthcare Provider Details

I. General information

NPI: 1215576236
Provider Name (Legal Business Name): JOCELYN RAQUEL RAEDEKER-FREITAS BSN, RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN RAQUEL FREITAS

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 B ST
SAN DIEGO CA
92102-2359
US

IV. Provider business mailing address

3165 B ST
SAN DIEGO CA
92102-2359
US

V. Phone/Fax

Practice location:
  • Phone: 619-822-4507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number7516123688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN95215783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: