Provider Demographics
NPI:1447531801
Name:ALFARO, JESUS MAURICIO JR (RN,MSN,ACNP-BC)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MAURICIO
Last Name:ALFARO
Suffix:JR
Gender:M
Credentials:RN,MSN,ACNP-BC
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:MAURICIO
Other - Last Name:ALFARO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RN,MSN,ACNP-BC
Mailing Address - Street 1:227 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1028
Mailing Address - Country:US
Mailing Address - Phone:650-438-9251
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-498-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20433363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care