=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952964744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEROMY ASIDO NP PSYCHIATRIC NURSING SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2019
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 N FLOWER ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92703-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-647-6017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13174 58TH ST
-----------------------------------------------------
City | EASTVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92880-4601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-260-1215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEROMY CRUZ ASIDO
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 714-260-1215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------