Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | NP8908 | CA |
NPI | 1003180498 |
---|---|
Provider Name | Mr. Gerardo M De Jesus |
First Address | Chino Hills, CA 91709-3927 |
Second Address | Santa Ana, CA 92703-2361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2012 |
Last Update Date | 02/03/2012 |