Active NPI
Jerome Freeman
- Licensed Vocational Nurse
- Pomona, CA
National Provider Identifier
1346465614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 259990
- Practice address
- 160 E Holt Ave Ste B
Pomona, CA 91767-5407 - Phone
- (909) 620-2521
- Fax
- (909) 620-9793
- NPI assigned
- Apr 13, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 259990 | CA | Primary |
Addresses
Primary practice location
160 E Holt Ave Ste B
Pomona, CA 91767-5407
Mailing address
168 W Walnut Ave Apt D
Rialto, CA 92376-3412
Phone (909) 620-2521
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 |
|---|---|---|---|
| 259990 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543449600000",
"number": "1346465614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "168 W WALNUT AVE APT D",
"city": "RIALTO",
"state": "CA",
"postal_code": "923763412",
"telephone_number": "909-620-2521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E HOLT AVE STE B",
"city": "POMONA",
"state": "CA",
"postal_code": "917675407",
"telephone_number": "909-620-2521",
"fax_number": "909-620-9793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREEMAN",
"first_name": "JEROME",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2018-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "259990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.