Healthcare Provider Details

I. General information

NPI: 1013298934
Provider Name (Legal Business Name): JIM JASON FRANCISCO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S ARROYO PKWY
PASADENA CA
91105-3911
US

IV. Provider business mailing address

16969 ROBINS NEST WAY APT 2
SAN DIEGO CA
92127-3355
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-4894
  • Fax:
Mailing address:
  • Phone: 858-722-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number705940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: