Provider Demographics
NPI:1831856913
Name:NOBAKHT, JACLYN MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MARIE
Last Name:NOBAKHT
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 1:26661 VIA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6126
Mailing Address - Country:US
Mailing Address - Phone:949-374-1696
Mailing Address - Fax:
Practice Address - Street 1:27281 LAS RAMBLAS STE 236
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6324
Practice Address - Country:US
Practice Address - Phone:949-228-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019193363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health