Healthcare Provider Details

I. General information

NPI: 1497043814
Provider Name (Legal Business Name): MR. FERNANDO JAUREGUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1222
US

IV. Provider business mailing address

112 FRANKLIN AVE
SOUTH SAN FRANCISCO CA
94080-1631
US

V. Phone/Fax

Practice location:
  • Phone: 650-372-3282
  • Fax:
Mailing address:
  • Phone: 650-291-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: