Individual
JACQUELYN SMITH-DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
150 PAULARINO AVE, COSTA MESA, CA 92626-3301
(949) 556-3433
Mailing address
8441 RENWICK DR, CORONA, CA 92883-5931
(323) 251-0477
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F07210327
CA
Other
Enumeration date
07/07/2021
Last updated
12/29/2022
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