Maria Corazon Jose Jara, RN, PHN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN288512 Issued in CA

Practice address

1845 N Fair Oaks Ave
Pasadena, CA 91103-1620

Phone

(626) 744-6005

Fax

(626) 744-6115

NPI assigned

May 18, 2007

Sex

Female

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518175033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 MILTON DR",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917752823",
            "telephone_number": "626-744-6041",
            "fax_number": "626-744-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 N FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031620",
            "telephone_number": "626-744-6005",
            "fax_number": "626-744-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JARA",
        "first_name": "MARIA CORAZON",
        "middle_name": "JOSE",
        "name_prefix": "Mrs.",
        "credential": "RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "CA",
            "license": "RN288512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "RN288512",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Administrator Registered Nurse in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Administrator Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.