Individual
JACQLYN QUINTINA WAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
27201 PUERTA REAL STE 300, MISSION VIEJO, CA 92691-8590
(949) 354-4147
Mailing address
1206 BLUE SKY DR, CARDIFF, CA 92007-1005
(858) 213-7243
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSB94024446
CA
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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