Provider Demographics
NPI:1578803029
Name:QUIRARTE, JESUS (PMHNP)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:QUIRARTE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:QUIRARTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:255 TERRACINA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-798-1763
Mailing Address - Fax:
Practice Address - Street 1:255 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-798-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA829189163W00000X
CA2019060742363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124100383Medicaid