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General NPI Number Information
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NPI Number | 1790167328
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Entity Type | Individual
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Provider Name | JESSICA BLAIR PNP
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 333 CORPORATE DR STE 200
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City | LADERA RANCH
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State | CA
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Zip | 92694-2179
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Country | US
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Telephone | 949-347-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 21882 JINETES
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City | MISSION VIEJO
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State | CA
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Zip | 92691-1114
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Country | US
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Telephone | 310-897-1840
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95007023
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License Number State | CA
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