MEDICARE: JESUS PACIS NP

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	163W00000X	Registered Nurse	95022921	CA
2	363L00000X	Nurse Practitioner	95022921	CA

General Provider Information

NPI Number	:	1215645122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS PACIS NP

Provider Business Mailing Address
First Line	:	742 W HIGHLAND AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3839
Country	:	US
Telephone Number	:	909-881-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	7576 STERLING AVE STE C-D
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410-4273
Country	:	US
Telephone Number	:	909-381-8983
Fax Number	:

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

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/15/2022

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Directions to “ JESUS PACIS NP” Practice Location

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