Provider Demographics
NPI:1003180498
Name:DE JESUS, GERARDO M (NP)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:M
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:GERRY
Other - Middle Name:M
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:17989 VIA FRONTERA
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3927
Mailing Address - Country:US
Mailing Address - Phone:760-668-8458
Mailing Address - Fax:
Practice Address - Street 1:550 N FLOWER ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2361
Practice Address - Country:US
Practice Address - Phone:714-647-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8908363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health