Provider Demographics
NPI:1881342277
Name:KARAGUEZIAN, JESSICA DIANA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DIANA
Last Name:KARAGUEZIAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5943 ENCINITA AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1933
Mailing Address - Country:US
Mailing Address - Phone:626-628-4528
Mailing Address - Fax:
Practice Address - Street 1:5943 ENCINITA AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1933
Practice Address - Country:US
Practice Address - Phone:626-628-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner