Provider Demographics
NPI:1558098566
Name:DE JESUS, JOSEPH LAO (FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAO
Last Name:DE JESUS
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 1:146 N HILL ST
Mailing Address - Street 2:
Mailing Address - City:ARVIN
Mailing Address - State:CA
Mailing Address - Zip Code:93203-1014
Mailing Address - Country:US
Mailing Address - Phone:661-855-4468
Mailing Address - Fax:
Practice Address - Street 1:146 N HILL ST
Practice Address - Street 2:
Practice Address - City:ARVIN
Practice Address - State:CA
Practice Address - Zip Code:93203-1014
Practice Address - Country:US
Practice Address - Phone:661-855-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA572618903Medicaid