Provider Demographics
NPI:1659108611
Name:LABONTE, JACQUELINE (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LABONTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 GIRARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4435
Mailing Address - Country:US
Mailing Address - Phone:858-230-2876
Mailing Address - Fax:
Practice Address - Street 1:7661 GIRARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4435
Practice Address - Country:US
Practice Address - Phone:858-230-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily