Healthcare Provider Details

I. General information

NPI: 1043666092
Provider Name (Legal Business Name): JAIME ZELEDON N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 S SAN JACINTO AVE STE A-CD
SAN JACINTO CA
92583-5103
US

IV. Provider business mailing address

7726 WHITNEY DR
JURUPA VALLEY CA
92509-5434
US

V. Phone/Fax

Practice location:
  • Phone: 951-330-3100
  • Fax: 951-380-8596
Mailing address:
  • Phone: 626-827-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95004298
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: