Individual
JETTELE JOY D LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1135 S SUNSET AVE STE 401, WEST COVINA, CA 91790-3921
(626) 732-8393
Mailing address
1405 PARTRIDGE LN, GLENDORA, CA 91740-4529
(626) 347-2988
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95019623
CA
Other
Enumeration date
09/12/2022
Last updated
02/01/2024
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