Provider Demographics
NPI:1477075463
Name:ABELLA-DESUYO, JEANNA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:LYNN
Last Name:ABELLA-DESUYO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:LYNN
Other - Last Name:ABELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30270 RANCHO VIEJO RD
Mailing Address - Street 2:STE E
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1556
Mailing Address - Country:US
Mailing Address - Phone:949-716-3930
Mailing Address - Fax:
Practice Address - Street 1:30270 RANCHO VIEJO RD
Practice Address - Street 2:STE E
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1556
Practice Address - Country:US
Practice Address - Phone:949-716-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor