Healthcare Provider Details

I. General information

NPI: 1386596963
Provider Name (Legal Business Name): JOSE PEVEN JUMILLA ARIOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E COMMONWEALTH AVE APT 318
FULLERTON CA
92832-4908
US

IV. Provider business mailing address

229 E COMMONWEALTH AVE APT 318
FULLERTON CA
92832-4908
US

V. Phone/Fax

Practice location:
  • Phone: 559-430-4179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95254029
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95039872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: