Provider Demographics
NPI:1437709524
Name:ALDAZ, JOSE RAMON
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAMON
Last Name:ALDAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14802 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6243
Mailing Address - Country:US
Mailing Address - Phone:562-786-0995
Mailing Address - Fax:
Practice Address - Street 1:1001 S HALE AVE SPC 54
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-2177
Practice Address - Country:US
Practice Address - Phone:760-739-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1151262OtherDRIVER LICENSE