Provider Demographics
NPI:1407834252
Name:CEJA, JESUS (FNP)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:CEJA
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 1:812 E D ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9545
Mailing Address - Country:US
Mailing Address - Phone:559-925-1000
Mailing Address - Fax:559-925-1085
Practice Address - Street 1:812 E D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9545
Practice Address - Country:US
Practice Address - Phone:559-925-1000
Practice Address - Fax:559-925-1085
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46483Medicare UPIN