Provider Demographics
NPI:1235807405
Name:CLAUSI, JILLIAN RAE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:CLAUSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10582 LA FUENTE ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4813
Mailing Address - Country:US
Mailing Address - Phone:714-309-0366
Mailing Address - Fax:
Practice Address - Street 1:10582 LA FUENTE ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4813
Practice Address - Country:US
Practice Address - Phone:714-309-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse