Individual
JACQUELINE JIAQI CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
675 W FOOTHILL BLVD STE 200, CLAREMONT, CA 91711-3475
(925) 282-1778
(415) 296-5299
Mailing address
675 W FOOTHILL BLVD STE 200, CLAREMONT, CA 91711-3475
(925) 282-1778
(415) 296-5299
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95126081
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95025416
CA
Other
Enumeration date
02/16/2023
Last updated
05/16/2025
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