Individual
DIANE MARIE JACQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
8318 BELLA VISTA DR, RANCHO CUCAMONGA, CA 91701-1332
(909) 466-9944
(909) 466-9944
Mailing address
8318 BELLA VISTA DR, RANCHO CUCAMONGA, CA 91701-1332
(909) 466-9944
(909) 466-9944
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
397229
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EPS014670
MEDI-CAL
CA
01
—
RVN003010
MEDI-CAL
CA
Enumeration date
10/15/2006
Last updated
07/08/2007
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