Provider Demographics
NPI:1649163965
Name:DE JESUS, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DE JESUS
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 1:34888 SILVERSPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8429
Mailing Address - Country:US
Mailing Address - Phone:760-577-5052
Mailing Address - Fax:
Practice Address - Street 1:34888 SILVERSPRINGS PL
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-8429
Practice Address - Country:US
Practice Address - Phone:760-577-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)