Individual provider Active NPI

Jessica Lozano Tea

  • Critical Care Medicine Registered Nurse
  • Fontana, CA
National Provider Identifier
1003624305
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Registered NurseTaxonomy code 163WC0200X
License
95059478 Issued in CA
Practice address
16941 Backwater LN
Fontana, CA 92336-2197
Phone
(909) 670-5342
NPI assigned
Dec 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 95059478 CA Primary

Addresses

Primary practice location

16941 Backwater LN
Fontana, CA 92336-2197

Mailing address

16941 Backwater LN
Fontana, CA 92336-2197
Phone (909) 670-5342

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

LicenseStateTypeSpecialty
95059478CAMDCritical Care Medicine Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1003624305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16941 BACKWATER LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362197",
            "telephone_number": "909-670-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16941 BACKWATER LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362197",
            "telephone_number": "909-670-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEA",
        "first_name": "JESSICA",
        "middle_name": "LOZANO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-19",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "CA",
            "license": "95059478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.