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General NPI Number Information
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NPI Number | 1558454355
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Entity Type | Individual
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Provider Name | JUSTINA M BRESENO MD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6485 DAY ST SUITE 103
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City | RIVERSIDE
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State | CA
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Zip | 92507-0929
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Country | US
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Telephone | 714-777-2593
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Fax |
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Provider Business Mailing Address
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Address Line | 20365 SHAKARI CIRCLE
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City | YORBA LINDA
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State | CA
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Zip | 92887
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Country | US
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Telephone | 951-601-6802
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Fax | 951-604-9263
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A50599
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License Number State | CA
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