Healthcare Provider Details

I. General information

NPI: 1669360475
Provider Name (Legal Business Name): ADELINE SUGENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44280 CAMPANULA WAY
TEMECULA CA
92592-7902
US

IV. Provider business mailing address

415 W GOLF RD STE 26
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 855-700-8184
  • Fax:
Mailing address:
  • Phone: 855-700-8184
  • Fax: 224-633-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: