Provider Demographics
NPI:1659660058
Name:THEIS, JINGYI (MSN, PMHNP)
Entity Type:Individual
Prefix:
First Name:JINGYI
Middle Name:
Last Name:THEIS
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52673
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-2673
Mailing Address - Country:US
Mailing Address - Phone:949-309-7903
Mailing Address - Fax:949-716-5243
Practice Address - Street 1:25411 CABOT RD. SUITE 206
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-309-7903
Practice Address - Fax:949-716-5243
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484436163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health