Provider Demographics
NPI:1760912364
Name:SAN JOSE, FERDINAND
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
Last Name:SAN JOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 MARQUIS CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3127
Mailing Address - Country:US
Mailing Address - Phone:661-703-3779
Mailing Address - Fax:
Practice Address - Street 1:1954 MARQUIS COURT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913
Practice Address - Country:US
Practice Address - Phone:661-703-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse