Healthcare Provider Details

I. General information

NPI: 1598562969
Provider Name (Legal Business Name): JAYLA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4206
US

IV. Provider business mailing address

5888 GINGER DR
EASTVALE CA
92880-4626
US

V. Phone/Fax

Practice location:
  • Phone: 714-312-7519
  • Fax:
Mailing address:
  • Phone: 310-489-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number741570
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number741570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: