Healthcare Provider Details

I. General information

NPI: 1891673315
Provider Name (Legal Business Name): JAKELIN BUENROSTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 E LEVIN AVE
TULARE CA
93274-6674
US

IV. Provider business mailing address

1427 E LEVIN AVE
TULARE CA
93274-6674
US

V. Phone/Fax

Practice location:
  • Phone: 559-936-8067
  • Fax:
Mailing address:
  • Phone: 559-936-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95036029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: