Provider Demographics
NPI:1568775641
Name:TOVAR, JOSE (NP)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:TOVAR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:TOVARMENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 54130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0130
Mailing Address - Country:US
Mailing Address - Phone:951-687-3200
Mailing Address - Fax:951-687-8923
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 211
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-323-1155
Practice Address - Fax:760-325-8629
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 19501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner