=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982040515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENILYN PALISOC PEROS DNP, FNP-C, MSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2013
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2204 GARNET AVE STE 209C
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92109-3771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-439-0455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4231 BALBOA AVE # 302
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-439-0455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 23695
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------