Basic Information
| Provider Information | |||||||||
| NPI: | 1952964744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEROMY ASIDO NP PSYCHIATRIC NURSING SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 W ROUTE 66 STE 202 | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917404335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269634467 | ||||||||
| FaxNumber: | 6269639543 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 W ROUTE 66 STE 202 | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917404335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269634467 | ||||||||
| FaxNumber: | 6269639543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | ASIDO | ||||||||
| AuthorizedOfficialFirstName: | JEROMY | ||||||||
| AuthorizedOfficialMiddleName: | CRUZ | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6269634467 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PMHNP-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.