MEDICARE: ARDENT NEXUS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043166051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDENT NEXUS, INC

Provider Business Mailing Address
First Line	:	3583 HAWTHORNE DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-8480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3583 HAWTHORNE DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-8480
Country	:	US
Telephone Number	:	951-818-2636
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHUJA AYOUBY
Credential	:	DO
Telephone Number	:	951-818-2636

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ARDENT NEXUS, INC ” Practice Location

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