Healthcare Provider Details

I. General information

NPI: 1174439350
Provider Name (Legal Business Name): JEREMIE R BUCKLEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 DAY CREEK BLVD
RANCHO CUCAMONGA CA
91739-8549
US

IV. Provider business mailing address

37434 GLENOAKS RD
TEMECULA CA
92592-8138
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-422-3006
Mailing address:
  • Phone: 951-466-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number95237773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: