Tiffany De Jesus

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95022332 Issued in CA

Practice address

1310 San Bernardino Rd Ste 105
Upland, CA 91786-4985

Phone

(909) 429-2864

NPI assigned

Feb 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cucamonga Valley Medical Group IncGroup PAC ID 6709899883, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Cucamonga Valley Medical Group, Inc.

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1497783229
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  Care Compare affiliation

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1447799739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD STE 105",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864985",
            "telephone_number": "909-429-2864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD STE 105",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864985",
            "telephone_number": "909-429-2864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26922 Oso Pkwy Ste 380",
            "address_purpose": "LOCATION",
            "city": "Mission Viejo",
            "state": "CA",
            "postal_code": "926915800",
            "country_code": "US",
            "telephone_number": "949-305-0110",
            "fax_number": "949-305-0101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE JESUS",
        "first_name": "TIFFANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-20",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "CA",
            "license": "720787",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "720787",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95022332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawson Dialysis LLC
• Theresa Dawson
• Decerie Baculi Dayag, MD
• Daystar Medical Corporation
• Michelle Angela Dazalla, LMFT
• Sabrina Serah De Leon
• Megan Dean, RN, IBCLC
• Deborah Vandenboom
• Dulce R Decastro, MD
• Deepaaleya Medical Inc.

• Family Nurse Practitioner in Upland, CA
• Providers in Upland, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.