Individual
JESSE REVIN SITUMEANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
71952 BUENA VISTA DR, 29 PALMS, CA 92277-2076
(720) 666-0999
(760) 401-8212
Mailing address
71952 BUENA VISTA DR, 29 PALMS, CA 92277-2076
(720) 666-0999
(760) 401-8212
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
243146
CA
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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