MEDICARE: EASTER VELMER JIMENEA MASUECOS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11016160	FL
2	363LF0000X	Family Nurse Practitioner	95019214	CA

General Provider Information

NPI Number	:	1134889868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EASTER VELMER JIMENEA MASUECOS FNP-BC

Provider Business Mailing Address
First Line	:	426 PARKVIEW AVE
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-5232
Country	:	US
Telephone Number	:	310-507-4568
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 PARKVIEW AVE
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-5232
Country	:	US
Telephone Number	:	310-507-4568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	02/12/2022

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