Healthcare Provider Details

I. General information

NPI: 1528340015
Provider Name (Legal Business Name): MINA MARIAN HUTCHFUL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 CLEGHORN CT
FONTANA CA
92336-4553
US

IV. Provider business mailing address

5965 CLEGHORN CT KUMS
FONTANA CA
92336-4553
US

V. Phone/Fax

Practice location:
  • Phone: 951-536-0245
  • Fax: 909-251-4068
Mailing address:
  • Phone: 951-536-0245
  • Fax: 909-251-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number450939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: