Jesse J. Jacquez, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10031 Issued in CA

Practice address

895 W Valley Blvd
Colton, CA 92324-2001

Phone

(909) 824-3389

Fax

(909) 824-1087

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bolivar Family Medical Clinic a Medical Corporation

  • Specialist
  • Riverside, CA
  • NPI 1215991534
  Medicare reassignment
• Pacifica Health & Wellness Clinic, Inc.

  • General Practice Physician
  • Riverside, CA
  • NPI 1538497813
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1285644294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 W VALLEY BLVD",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923242001",
            "telephone_number": "909-824-3389",
            "fax_number": "909-824-1087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 W VALLEY BLVD",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923242001",
            "telephone_number": "909-824-3389",
            "fax_number": "909-824-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUEZ",
        "first_name": "JESSE",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA10031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659483352",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0071450",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breyana Jackson
• Carey Lucile Jackson, MA
• Jennifer Jackson, MD
• Geonna Jacobs
• Marilyn Frances Jacobs
• Maryellie Jacquez
• Erin Jaeger, PA-C
• Ned-Louise Jaggers, OTA/L
• Anika Jallorina
• Ali Jamehdor, D.O

• Medical Physician Assistant in Colton, CA
• Providers in Colton, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.