Individual
KEVIN JERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
405 W 5TH ST, SANTA ANA, CA 92701-4599
(714) 695-1590
Mailing address
405 W 5TH ST, SANTA ANA, CA 92701-4599
(714) 695-1590
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
493813
CA
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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