Healthcare Provider Details

I. General information

NPI: 1962094474
Provider Name (Legal Business Name): JALEE DUDDING NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JALEE WESOLOWSKI

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18080 IMPERIAL HWY
YORBA LINDA CA
92886-3436
US

IV. Provider business mailing address

2517 W VIA ACOSTA
MONTEBELLO CA
90640-2345
US

V. Phone/Fax

Practice location:
  • Phone: 714-961-1054
  • Fax:
Mailing address:
  • Phone: 323-695-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: