Healthcare Provider Details

I. General information

NPI: 1598639171
Provider Name (Legal Business Name): JADEN TAYLOR MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CLUB DR
VALLEJO CA
94592-1187
US

IV. Provider business mailing address

3146 STARDUST ST
ROCKLIN CA
95677-1724
US

V. Phone/Fax

Practice location:
  • Phone: 707-638-5200
  • Fax:
Mailing address:
  • Phone: 916-300-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: