Basic Information
| Provider Information | |||||||||
| NPI: | 1477988244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARIAZO | ||||||||
| FirstName: | JILL ROSE | ||||||||
| MiddleName: | URCIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 INLAND EMPIRE BLVD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094581350 | ||||||||
| FaxNumber: | 9095798149 | ||||||||
| Practice Location | |||||||||
| Address1: | 2940 INLAND EMPIRE BLVD. | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094581350 | ||||||||
| FaxNumber: | 9095798149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2013 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN707130 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.