Jackelyn Anty-Garcia

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Yucaipa, CA

NPI 1417780693 · NPPES record last updated Aug 22, 2024

Key facts

NPI
1417780693
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
12587 3Rd St
Yucaipa, CA 92399-4542
Phone
(909) 492-2839
NPI assigned
Aug 22, 2024
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

12587 3Rd St
Yucaipa, CA 92399-4542

Mailing address

12587 3Rd St
Yucaipa, CA 92399-4542
Phone (909) 492-2839

Other providers in Yucaipa, CA

All providers in Yucaipa, CA · Student in an Organized Health Care Education/Training Program in California

Sources for this page

Verify at the official NPI Registry.