Jaeson M Fetalvero

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

218256 Issued in CA

Practice address

7246 Remmet Ave
Canoga Park, CA 91303-1531

Phone

(818) 206-0630

NPI assigned

Aug 18, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Aegis Treatment Centers, LLC

  • Methadone Clinic
  • Banning, CA
  • NPI 1376293407
  NPD (past)
• Aegis Treatment Centers, LLC

  • Methadone Clinic
  • Canoga Park, CA
  • NPI 1831601764
  NPD (past)

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1356953848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3834 COLMA AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953488719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7246 REMMET AVE",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913031531",
            "telephone_number": "818-206-0630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1235 McHenry Ave Ste A&b",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953505370",
            "country_code": "US",
            "telephone_number": "209-527-4597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FETALVERO",
        "first_name": "JAESON",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2021-05-21",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CA",
            "license": "218256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Fernandez
• Brenda Zamora Fernandez
• Marina Fernandez
• Yosemite Ferreira
• Jesenia Elizabeth Ferrer
• Sarah Margaret Fiedler, FNP
• Hasani Fields
• Aedan Fierro
• Alberto Figueroa
• Brianna Figueroa

• Licensed Practical Nurse in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• Licensed Practical Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.