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General NPI Number Information
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NPI Number | 1215682729
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Entity Type | Individual
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Provider Name | MRS. INEZ JUNE EZEA
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Gender | Female
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 HEARTLAND WAY
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City | CORONA
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State | CA
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Zip | 92881-4186
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Country | US
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Telephone | 714-420-9554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 640168
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP95028086
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License Number State | CA
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