Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 95004298 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95004298 | CA |
NPI | 1043666092 |
---|---|
Provider Name | Jaime Zeledon |
First Address | Newport Beach, CA 92660-2616 |
Second Address | Rancho Mirage, CA 92270-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 21/08/2017 |