Provider Demographics
NPI:1659939510
Name:NAVARRO, JESUS (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:JESUS
Other - Middle Name:
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2068 ORANGE TREE LN STE 215
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4555
Mailing Address - Country:US
Mailing Address - Phone:909-651-4837
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST.
Practice Address - Street 2:SCHUMAN PAVILION 1637
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011846363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95011846OtherNURSE PRACTITIONER
CA95011846OtherNP FURNISHING