Provider Demographics
NPI:1083399430
Name:CONTRERAS, JEFFREY SR (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CONTRERAS
Suffix:SR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80129 PEAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1293 6TH ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1707
Practice Address - Country:US
Practice Address - Phone:760-391-5151
Practice Address - Fax:760-391-5159
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9502597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily