Healthcare Provider Details

I. General information

NPI: 1083548150
Provider Name (Legal Business Name): KASHMONA U BRIDGET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 5TH ST
RANCHO CUCAMONGA CA
91730-5952
US

IV. Provider business mailing address

13660 LEXUS LN
FONTANA CA
92335-0540
US

V. Phone/Fax

Practice location:
  • Phone: 909-202-7593
  • Fax:
Mailing address:
  • Phone: 909-202-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number950399929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: