Provider Demographics
NPI:1255184081
Name:CALL, JACQUELYN BROOKE
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:BROOKE
Last Name:CALL
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 1:28021 PASEO DEL MARINO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3317
Mailing Address - Country:US
Mailing Address - Phone:714-864-0864
Mailing Address - Fax:
Practice Address - Street 1:2515 MCCABE WAY STE 350
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-9403
Practice Address - Country:US
Practice Address - Phone:714-864-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020526363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care