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General NPI Number Information
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NPI Number | 1225186505
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Entity Type | Organization
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Legal Business Name | JUSTINA M. BRESENO, M.D., INC.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6485 DAY ST STE 103
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City | RIVERSIDE
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State | CA
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Zip | 92507-0930
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Country | US
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Telephone | 951-653-1683
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Fax |
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Provider Business Mailing Address
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Address Line | 6485 DAY ST STE 103
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City | RIVERSIDE
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State | CA
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Zip | 92507-0930
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Country | US
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Telephone | 951-653-1683
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Fax | 951-653-1873
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTINA M. BRESENO
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Credential | M.D.
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Telephone | 951-653-1683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A50599
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License Number State | CA
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