Healthcare Provider Details

I. General information

NPI: 1033749270
Provider Name (Legal Business Name): BERNICE TAN DNP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N 13TH AVE STE 204
UPLAND CA
91786-4973
US

IV. Provider business mailing address

510 N 13TH AVE STE 204
UPLAND CA
91786-4973
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-0525
  • Fax:
Mailing address:
  • Phone: 909-920-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: