Basic Information
| Provider Information | |||||||||
| NPI: | 1780621821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERA | ||||||||
| FirstName: | JESUS | ||||||||
| MiddleName: | ADRIAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E VALENCIA MESA DR STE 206 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353817 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E VALENCIA MESA DR | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144465050 | ||||||||
| FaxNumber: | 7144465150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A82192 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | A82192 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00A821920 | 05 | CA | MEDICAID |