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NPI Code Detail

MEDICARE: JEILINE PUEBLA

MEDICARE: JEILINE PUEBLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1245185222
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEILINE PUEBLA
Provider Business Mailing Address
First Line : 27107 DOLLAR RD
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92241-8816
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11799 SEBASTIAN WAY STE 103
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-0708
Country : US
Telephone Number : 909-353-7547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 03/04/2026

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Directions to “ JEILINE PUEBLA ” Practice Location

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