Individual
MR. JESSE INGRAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9985 SIERRA AVE, FONTANA, CA 92335-6720
(909) 427-5525
(909) 427-7602
Mailing address
1033 LA MARILLO CIR, CORONA, CA 92879-8234
(909) 427-5525
(909) 427-7602
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA13419
CA
Other
Enumeration date
05/01/2007
Last updated
11/29/2021
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