Provider Demographics
NPI:1003624305
Name:TEA, JESSICA LOZANO
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOZANO
Last Name:TEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16941 BACKWATER LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2197
Mailing Address - Country:US
Mailing Address - Phone:909-670-5342
Mailing Address - Fax:
Practice Address - Street 1:16941 BACKWATER LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-2197
Practice Address - Country:US
Practice Address - Phone:909-670-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95059478163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine