Healthcare Provider Details

I. General information

NPI: 1770775058
Provider Name (Legal Business Name): IVANA JANICE BLUHM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W COLTON AVE SUITE E
REDLANDS CA
92374-2905
US

IV. Provider business mailing address

350 TERRACINA BLVD
REDLANDS CA
92373-4850
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-5799
  • Fax: 909-793-6614
Mailing address:
  • Phone: 909-335-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: