Healthcare Provider Details

I. General information

NPI: 1689923088
Provider Name (Legal Business Name): JEAN CATHERINE BERUMEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN CATHERINE DUGUAY

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 909-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number639692
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: