Provider Demographics
NPI:1255758256
Name:ST. JULES, JESSICA (PA- C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ST. JULES
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 S RIVERSIDE AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7586
Mailing Address - Country:US
Mailing Address - Phone:909-240-8322
Mailing Address - Fax:
Practice Address - Street 1:1036 S RIVERSIDE AVE APT 102
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7586
Practice Address - Country:US
Practice Address - Phone:909-240-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51332363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical