Basic Information
| Provider Information | |||||||||
| NPI: | 1487252656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARREOLA | ||||||||
| FirstName: | JIA NI | ||||||||
| MiddleName: | LIU | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 PROSPERITY ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOUSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953911112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155037205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 N CALIFORNIA ST | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952046019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099432000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2020 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 739245 | CA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 367500000X | 95001536 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.