Healthcare Provider Details

I. General information

NPI: 1225893175
Provider Name (Legal Business Name): RUSTINY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11354 MOUNTAIN VIEW AVE STE C
LOMA LINDA CA
92354-3855
US

IV. Provider business mailing address

11354 MOUNTAIN VIEW AVE STE C
LOMA LINDA CA
92354-3855
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-8400
  • Fax: 909-543-1828
Mailing address:
  • Phone: 909-796-8400
  • Fax: 909-543-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA P MANGUNSONG
Title or Position: CEO
Credential: MPT
Phone: 909-796-8400