Healthcare Provider Details

I. General information

NPI: 1376437392
Provider Name (Legal Business Name): JESSICA LYNN LORGERODRIGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ORANGEBURG AVE STE 3302401E
MODESTO CA
95355-3351
US

IV. Provider business mailing address

434 COLORADO AVE
MODESTO CA
95351-3218
US

V. Phone/Fax

Practice location:
  • Phone: 350-503-9068
  • Fax: 209-724-6034
Mailing address:
  • Phone: 350-503-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95336039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: