Provider Demographics
NPI:1144248410
Name:DE JESUS, VIOLETA M (MD)
Entity type:Individual
Prefix:DR
First Name:VIOLETA
Middle Name:M
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2037
Mailing Address - Country:US
Mailing Address - Phone:866-218-4697
Mailing Address - Fax:
Practice Address - Street 1:5870 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42337207R00000X
CAA48057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48057OtherCALIFORNIA MEDICAL BOARD
CAA48057OtherCALIFORNIA MEDICAL BOARD
KYK001504Medicare PIN
KYK001502Medicare PIN
CAF01493Medicare UPIN
KYK001506Medicare PIN
KYK001501Medicare PIN
KYK001505Medicare PIN
KYK001500Medicare PIN