Healthcare Provider Details

I. General information

NPI: 1508579665
Provider Name (Legal Business Name): JESSICA I CIFUENTES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 WALNUT AVE
CHINO CA
91710-2609
US

IV. Provider business mailing address

545 E ARROW HWY
POMONA CA
91767-2258
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-6446
  • Fax:
Mailing address:
  • Phone: 909-753-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: