Healthcare Provider Details

I. General information

NPI: 1467220442
Provider Name (Legal Business Name): BUPE MUSHILI PMHNP NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 09/02/2025
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W ROUTE 66 STE 202
GLENDORA CA
91740-4335
US

IV. Provider business mailing address

3400 INLAND EMPIRE BLVD STE 101
ONTARIO CA
91764-5577
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-4467
  • Fax: 626-963-9543
Mailing address:
  • Phone: 909-870-0160
  • Fax: 909-870-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. BUPE C MUSHILI
Title or Position: OWNER
Credential: PMHNP
Phone: 909-870-0160