Provider Demographics
NPI:1750021028
Name:LI, JESSA ROSE AMORA (MD)
Entity Type:Individual
Prefix:
First Name:JESSA ROSE
Middle Name:AMORA
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEDIATRIC RESIDENCY PROGRAM
Mailing Address - Street 2:2516 STOCKTON BLVD
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-2428
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC RESIDENCY PROGRAM
Practice Address - Street 2:2516 STOCKTON BLVD
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program