Healthcare Provider Details

I. General information

NPI: 1285489864
Provider Name (Legal Business Name): BETTINA DENNISE CHUA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19042 SOLEDAD CANYON RD
CANYON COUNTRY CA
91351-3362
US

IV. Provider business mailing address

19042 SOLEDAD CANYON RD
CANYON COUNTRY CA
91351-3362
US

V. Phone/Fax

Practice location:
  • Phone: 661-251-6300
  • Fax:
Mailing address:
  • Phone: 661-251-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: