Healthcare Provider Details

I. General information

NPI: 1215832449
Provider Name (Legal Business Name): JESLIE JENNIFER ALBA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PRECISION PARK LN
SAN YSIDRO CA
92173-1345
US

IV. Provider business mailing address

297 SYCAMORE RD
SAN YSIDRO CA
92173-2959
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 619-636-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: