Healthcare Provider Details

I. General information

NPI: 1871308346
Provider Name (Legal Business Name): JESSICA MICEL MROWCZYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

15248 ELEVENTH ST
VICTORVILLE CA
92395-3704
US

IV. Provider business mailing address

9594 TANZANITE AVE
HESPERIA CA
92344-8094
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-6099
  • Fax:
Mailing address:
  • Phone: 323-229-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95033528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: