Provider Demographics
NPI:1760288666
Name:JIONGCO, RACHELLE C (APRN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:C
Last Name:JIONGCO
Suffix:
Gender:
Credentials:APRN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 6TH AVE UNIT 1102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8624
Mailing Address - Country:US
Mailing Address - Phone:850-748-9599
Mailing Address - Fax:
Practice Address - Street 1:5 HUTTON CENTRE DR STE 950
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-8714
Practice Address - Country:US
Practice Address - Phone:855-434-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health