Active NPI
Christiana De Jesus, PA-C
- Physician Assistant
- Walnut, CA
National Provider Identifier
1003450214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA57162
- Practice address
- 1362 Glenthorpe Dr
Walnut, CA 91789-3858 - Phone
- (909) 576-7810
- NPI assigned
- Oct 30, 2019
- Last updated
- Dec 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA57162 | CA | Primary |
Addresses
Primary practice location
1362 Glenthorpe Dr
Walnut, CA 91789-3858
Mailing address
770 Magnolia Ave Ste 2a
Corona, CA 92879-3122
Phone (951) 736-8144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA57162 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576454400000",
"number": "1003450214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "770 MAGNOLIA AVE STE 2A",
"city": "CORONA",
"state": "CA",
"postal_code": "928793122",
"telephone_number": "951-736-8144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1362 GLENTHORPE DR",
"city": "WALNUT",
"state": "CA",
"postal_code": "917893858",
"telephone_number": "909-576-7810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE JESUS",
"first_name": "CHRISTIANA",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-30",
"last_updated": "2019-12-16",
"certification_date": "2019-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA57162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.