Provider Demographics
NPI:1598018145
Name:ARTAGAME, JESSIE FRANCISCO
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:FRANCISCO
Last Name:ARTAGAME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HAZELDELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-5205
Mailing Address - Country:US
Mailing Address - Phone:951-487-1077
Mailing Address - Fax:951-413-0281
Practice Address - Street 1:500 HAZELDELL AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-5205
Practice Address - Country:US
Practice Address - Phone:951-487-1077
Practice Address - Fax:951-413-0281
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver