Provider Demographics
NPI:1255924130
Name:ASISTIO, JEEAN
Entity type:Individual
Prefix:
First Name:JEEAN
Middle Name:
Last Name:ASISTIO
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 1:44896 POPPY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4179
Mailing Address - Country:US
Mailing Address - Phone:619-933-3903
Mailing Address - Fax:
Practice Address - Street 1:44896 POPPY RIDGE DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4179
Practice Address - Country:US
Practice Address - Phone:619-933-3903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702155164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse