Healthcare Provider Details

I. General information

NPI: 1265297790
Provider Name (Legal Business Name): JOMAR DELA CRUZ DELIGUIN RN, BSN, RNFA, CNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

1552 ASPIRE WAY
MODESTO CA
95356-8007
US

V. Phone/Fax

Practice location:
  • Phone: 206-526-4500
  • Fax:
Mailing address:
  • Phone: 480-334-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95234722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: