Healthcare Provider Details

I. General information

NPI: 1558454355
Provider Name (Legal Business Name): JUSTINA M BRESENO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUSTINA ROBLES MARTIN MD

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6485 DAY ST SUITE 103
RIVERSIDE CA
92507-0929
US

IV. Provider business mailing address

20365 SHAKARI CIRCLE
YORBA LINDA CA
92887
US

V. Phone/Fax

Practice location:
  • Phone: 714-777-2593
  • Fax:
Mailing address:
  • Phone: 951-601-6802
  • Fax: 951-604-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: