Individual
JISHA PANGOTTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2295 S VINEYARD AVE, ONTARIO, CA 91761-7925
(909) 724-3940
Mailing address
2295 S VINEYARD AVE, ONTARIO, CA 91761-7925
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
NP95009215
CA
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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