Healthcare Provider Details

I. General information

NPI: 1366280133
Provider Name (Legal Business Name): EVA USSHER LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N E ST FL 4
SAN BERNARDINO CA
92401-1540
US

IV. Provider business mailing address

14936 GENOA DR
FONTANA CA
92336-1074
US

V. Phone/Fax

Practice location:
  • Phone: 909-757-7611
  • Fax:
Mailing address:
  • Phone: 909-714-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberVN165380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: