Healthcare Provider Details

I. General information

NPI: 1477537140
Provider Name (Legal Business Name): SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N. MT. VIEW AVE.
SAN BERNARDINO CA
92415-0001
US

IV. Provider business mailing address

10332 CHARWOOD CT
ALTA LOMA CA
91737-3076
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-6224
  • Fax:
Mailing address:
  • Phone: 909-466-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11125
License Number StateCA

VIII. Authorized Official

Name: MRS. LORNA MAUREEN NYBERG
Title or Position: FAMILY NURSE PRACTITIONER
Credential: F.N.P.
Phone: 909-466-5974