Provider Demographics
NPI:1528342607
Name:DAUZ, JOHNNY DEMETRIA III (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:DEMETRIA
Last Name:DAUZ
Suffix:III
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8750 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9156
Mailing Address - Country:US
Mailing Address - Phone:408-688-6807
Mailing Address - Fax:
Practice Address - Street 1:1004 W FOOTHILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3791
Practice Address - Country:US
Practice Address - Phone:909-985-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily