Healthcare Provider Details

I. General information

NPI: 1982551925
Provider Name (Legal Business Name): MARDON ROMULO ABESAMIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25534 HURON ST
LOMA LINDA CA
92354-3721
US

IV. Provider business mailing address

25534 HURON ST
LOMA LINDA CA
92354-3721
US

V. Phone/Fax

Practice location:
  • Phone: 909-809-1621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039015
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95262145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: