Healthcare Provider Details

I. General information

NPI: 1194175752
Provider Name (Legal Business Name): ROBIN PUESCHEL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 BARTON RD STE 101B
LOMA LINDA CA
92354-3139
US

IV. Provider business mailing address

25455 BARTON RD STE 101B
LOMA LINDA CA
92354-3139
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2808
  • Fax:
Mailing address:
  • Phone: 909-558-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95003933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: