Healthcare Provider Details

I. General information

NPI: 1437435401
Provider Name (Legal Business Name): JESSICA CHRISTINA OQUENDO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2011
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FALLON RD
BAY SHORE NY
11706-1302
US

IV. Provider business mailing address

30 FALLON RD
BAY SHORE NY
11706-1302
US

V. Phone/Fax

Practice location:
  • Phone: 631-291-0802
  • Fax:
Mailing address:
  • Phone: 631-291-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: