MEDICARE: MRS. JADINE VELARDE

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366215816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JADINE VELARDE

Provider Business Mailing Address
First Line	:	5555 RESERVOIR DR STE 204-A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5134
Country	:	US
Telephone Number	:	619-822-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 RESERVOIR DR # 204-A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5134
Country	:	US
Telephone Number	:	619-822-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	03/10/2026

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