Provider Demographics
NPI:1215583836
Name:DE JUAITING, JENELLE CHARMANE FRANCISCO (RN)
Entity type:Individual
Prefix:MS
First Name:JENELLE CHARMANE
Middle Name:FRANCISCO
Last Name:DE JUAITING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 VERBENA CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6911
Mailing Address - Country:US
Mailing Address - Phone:323-369-2559
Mailing Address - Fax:
Practice Address - Street 1:1040 VERBENA CT
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6911
Practice Address - Country:US
Practice Address - Phone:323-369-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA767558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse