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General NPI Number Information
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NPI Number | 1174486146
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Entity Type | Individual
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Provider Name | JACQUELYN REBOSA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 3313 HYLAND AVE
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City | COSTA MESA
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State | CA
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Zip | 92626-1550
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Country | US
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Telephone | 714-716-5031
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 E CORNWALL ST
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City | ONTARIO
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State | CA
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Zip | 91761-7947
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95033794
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License Number State | CA
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