Provider Demographics
NPI:1811722572
Name:DOSTIS, JILLIAN GRACE (BA)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:GRACE
Last Name:DOSTIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25002 REFLEJO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2723
Mailing Address - Country:US
Mailing Address - Phone:949-572-4264
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4469
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-475-5575
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician