MEDICARE: JACKLYN STOTTS JOYO MD

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	207N00000X	Dermatology Physician	G48848	CA

General Provider Information

NPI Number	:	1477541415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYN STOTTS JOYO MD

Provider Business Mailing Address
First Line	:	3401 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7933
Country	:	US
Telephone Number	:	714-427-7902
Fax Number	:	714-427-7915

Provider Business Practice Location Address
First Line	:	3401 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7933
Country	:	US
Telephone Number	:	714-427-7902
Fax Number	:	714-427-7915

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	11/17/2021

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