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NPI Code Detail

MEDICARE: JERRY J CIMMARUSTI MD

MEDICARE: JERRY J CIMMARUSTI MD
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
1207R00000XInternal Medicine PhysicianA56323CA

General Provider Information

NPI Number : 1386603322
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY J CIMMARUSTI MD
Provider Business Mailing Address
First Line : 420 W ROWLAND ST
Second Line :
City : COVINA
State : CA
Zip : 91723-2943
Country : US
Telephone Number : 626-331-6411
Fax Number : 626-251-1560
Provider Business Practice Location Address
First Line : 420 W ROWLAND ST
Second Line :
City : COVINA
State : CA
Zip : 91723-2943
Country : US
Telephone Number : 626-331-6411
Fax Number : 626-251-1559
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2006
Last Update Date : 05/04/2021

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Directions to “ JERRY J CIMMARUSTI MD” Practice Location

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