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General NPI Number Information
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NPI Number | 1114393022
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Entity Type | Individual
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Provider Name | JURY OCLARIT RONQUILLO FNP
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Gender | Male
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 1085 N HARBOR BLVD
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City | ANAHEIM
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State | CA
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Zip | 92801-2417
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Country | US
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Telephone | 714-774-7777
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Fax | 714-399-4135
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Provider Business Mailing Address
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Address Line | 7077 MONROE AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-3823
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Country | US
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Telephone | 917-359-0858
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Fax | 714-723-6807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 95002787
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 723534
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License Number State | CA
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