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General NPI Number Information
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NPI Number | 1649606914
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Entity Type | Individual
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Provider Name | SUGUNA JAIKUMAR FNP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2079 COMPTON AVE STE 102
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City | CORONA
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State | CA
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Zip | 92881-7292
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Country | US
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Telephone | 951-735-9599
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Fax | 951-935-7585
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Provider Business Mailing Address
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Address Line | 2079 COMPTON AVE STE 102
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City | CORONA
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State | CA
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Zip | 92881-7292
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Country | US
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Telephone | 951-735-9599
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Fax | 951-935-7585
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95002785
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 506974
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License Number State | CA
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