Healthcare Provider Details

I. General information

NPI: 1710878277
Provider Name (Legal Business Name): JAYMEE CLARISSE LICERIO CRUZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 3RD ST
PATTERSON CA
95363-2501
US

IV. Provider business mailing address

101 N 3RD ST
PATTERSON CA
95363-2501
US

V. Phone/Fax

Practice location:
  • Phone: 209-892-6184
  • Fax:
Mailing address:
  • Phone: 209-892-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: