Individual
MR. JESSE J. JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
895 W VALLEY BLVD, COLTON, CA 92324-2001
(909) 824-3389
(909) 824-1087
Mailing address
895 W VALLEY BLVD, COLTON, CA 92324-2001
(909) 824-3389
(909) 824-1087
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10031
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659483352
—
CA
05
—
GR0071450
—
CA
Enumeration date
08/09/2006
Last updated
06/15/2023
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