Healthcare Provider Details

I. General information

NPI: 1518175033
Provider Name (Legal Business Name): MARIA CORAZON JOSE JARA RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

430 MILTON DR
SAN GABRIEL CA
91775-2823
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-6005
  • Fax: 626-744-6115
Mailing address:
  • Phone: 626-744-6041
  • Fax: 626-744-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN288512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: