Provider Demographics
NPI:1114393022
Name:RONQUILLO, JURY OCLARIT (FNP)
Entity Type:Individual
Prefix:
First Name:JURY
Middle Name:OCLARIT
Last Name:RONQUILLO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7077 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3823
Mailing Address - Country:US
Mailing Address - Phone:917-359-0858
Mailing Address - Fax:714-723-6807
Practice Address - Street 1:1085 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2417
Practice Address - Country:US
Practice Address - Phone:714-774-7777
Practice Address - Fax:714-399-4135
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002787163WG0000X
CA723534163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice