Provider Demographics
NPI:1568717239
Name:GUMARANG, JEANETTE RONDOLOS (ARNP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:RONDOLOS
Last Name:GUMARANG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16341 FOX HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4893
Mailing Address - Country:US
Mailing Address - Phone:323-640-4074
Mailing Address - Fax:
Practice Address - Street 1:16341 FOX HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-4893
Practice Address - Country:US
Practice Address - Phone:323-640-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily