Provider Demographics
NPI: | 1790179372 |
---|---|
Name: | NERIA, JERRY A (MD, MPH) |
Entity Type: | Individual |
Prefix: | |
First Name: | JERRY |
Middle Name: | A |
Last Name: | NERIA |
Suffix: | |
Gender: | M |
Credentials: | MD, MPH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 222 W HENDERSON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTERVILLE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93257-1731 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 559-784-5483 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 222 W HENDERSON AVE |
Practice Address - Street 2: | |
Practice Address - City: | PORTERVILLE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93257-1731 |
Practice Address - Country: | US |
Practice Address - Phone: | 559-784-5483 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-03-23 |
Last Update Date: | 2022-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A152045 | 207R00000X, 208M00000X, 207Q00000X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |