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General NPI Number Information
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NPI Number | 1447560362
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Entity Type | Organization
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Legal Business Name | JOSELYNNE JAQUES
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 10 FORTUNA W
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City | IRVINE
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State | CA
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Zip | 92620-1848
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Country | US
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Telephone | 714-235-3053
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Fax | 714-384-3899
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Provider Business Mailing Address
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Address Line | 10 FORTUNA W
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City | IRVINE
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State | CA
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Zip | 92620-1848
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Country | US
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Telephone | 714-235-3053
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Fax | 714-384-3899
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | ROBERT JAQUES
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Credential |
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Telephone | 714-272-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 13783
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License Number State | CA
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