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General NPI Number Information
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NPI Number | 1952791576
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Entity Type | Individual
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Provider Name | JOCELYN INACAY CRISOSTOMO FNP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 491 E ALESSANDRO BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92508-6071
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Country | US
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Telephone | 186-638-9272
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Fax |
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Provider Business Mailing Address
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Address Line | 31966 COTTONWOOD DR
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City | TEMECULA
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State | CA
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Zip | 92592-4100
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Country | US
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Telephone | 951-514-8143
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95001888
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License Number State | CA
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