Provider Demographics
NPI:1508219718
Name:ESKANDR, JAQUOLIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JAQUOLIN
Middle Name:
Last Name:ESKANDR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13741 ANDELE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3228
Mailing Address - Country:US
Mailing Address - Phone:714-705-3195
Mailing Address - Fax:
Practice Address - Street 1:9041 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3900
Practice Address - Country:US
Practice Address - Phone:951-687-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty