Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 17258 | CA |
NPI | 1013191840 |
---|---|
Provider Name | Paulo Narvaez Jusay |
First Address | Fullerton, CA 92833-1208 |
Second Address | Fullerton, CA 92833-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CN213Z | PTAN (01) | CA |