Individual
JAPETH SANDOVAL DEMETRIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
27 DE VAUSNEY PL, NUTLEY, NJ 07110-2610
(973) 342-5352
Mailing address
27 DE VAUSNEY PL, NUTLEY, NJ 07110-2610
(973) 342-5352
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00603600
NJ
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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