Healthcare Provider Details

I. General information

NPI: 1992636245
Provider Name (Legal Business Name): JACINDA NAKHONTHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 BEVERLY PL
SAN MARCOS CA
92078-3746
US

IV. Provider business mailing address

653 BEVERLY PL
SAN MARCOS CA
92078-3746
US

V. Phone/Fax

Practice location:
  • Phone: 619-602-2573
  • Fax:
Mailing address:
  • Phone:
  • 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: