Healthcare Provider Details

I. General information

NPI: 1295095271
Provider Name (Legal Business Name): JEREMY BUSCH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR STE 9
RIVERSIDE CA
92503-4001
US

IV. Provider business mailing address

3838 SHERMAN DRIVE SUITE 9
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-9228
  • Fax: 951-352-9357
Mailing address:
  • Phone: 951-352-9228
  • Fax: 951-352-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: