Healthcare Provider Details

I. General information

NPI: 1558765677
Provider Name (Legal Business Name): BARBARA KUTRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

10675 BRYANT ST SPC 25
YUCAIPA CA
92399-3052
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8638
  • Fax:
Mailing address:
  • Phone: 909-363-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95040469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: