Provider Demographics
NPI:1467083873
Name:ESTEBAN, JERSON DEREK (BSN RN)
Entity Type:Individual
Prefix:
First Name:JERSON
Middle Name:DEREK
Last Name:ESTEBAN
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 BALTIMORE DR APT 153
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0629
Mailing Address - Country:US
Mailing Address - Phone:858-705-9058
Mailing Address - Fax:
Practice Address - Street 1:5150 BALTIMORE DR APT 153
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0629
Practice Address - Country:US
Practice Address - Phone:858-705-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95186165163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health