Provider Demographics
NPI:1477988244
Name:CARIAZO, JILL ROSE URCIA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JILL ROSE
Middle Name:URCIA
Last Name:CARIAZO
Suffix:
Gender:F
Credentials:RN, BSN
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Other - First Name:
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Mailing Address - Street 1:2940 INLAND EMPIRE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4898
Mailing Address - Country:US
Mailing Address - Phone:909-458-1350
Mailing Address - Fax:909-579-8149
Practice Address - Street 1:2940 INLAND EMPIRE BLVD.
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-458-1350
Practice Address - Fax:909-579-8149
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN707130163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health