Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 95014349 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95014349 | CA |
NPI | 1023635513 |
---|---|
Provider Name | Chrystal Joy Dizon Jurado |
First Address | Hayward, CA 94541-4752 |
Second Address | Hayward, CA 94541-4752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 20/08/2020 |