Provider Demographics
NPI:1467062661
Name:POWELL, JESSICA L
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:POWELL
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 1:1119 E CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3505
Mailing Address - Country:US
Mailing Address - Phone:714-921-4087
Mailing Address - Fax:714-453-2493
Practice Address - Street 1:1119 E CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3505
Practice Address - Country:US
Practice Address - Phone:714-921-4087
Practice Address - Fax:714-453-2493
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator