Healthcare Provider Details

I. General information

NPI: 1043167547
Provider Name (Legal Business Name): MISS JADE ARLENE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N EUCLID AVE
UPLAND CA
91786-6031
US

IV. Provider business mailing address

2147 W 237TH ST
TORRANCE CA
90501-6016
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number819C44186F
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: