Healthcare Provider Details

I. General information

NPI: 1407498017
Provider Name (Legal Business Name): PROFESSIONAL NURSES GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 CHEYENNE WAY
CHINO CA
91710-5510
US

IV. Provider business mailing address

4845 CHEYENNE WAY
CHINO CA
91710-5510
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-8999
  • Fax: 626-382-0888
Mailing address:
  • Phone: 626-289-8999
  • Fax: 626-382-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HERMAN DJUHANA
Title or Position: OWNER
Credential:
Phone: 626-289-8999