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NPI Code Detail

MEDICARE: MICHELLE JUSTINE CORPUZ BONUS BSN, RN, CPHON

MEDICARE: MICHELLE JUSTINE CORPUZ BONUS BSN, RN, CPHON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1760010623
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE JUSTINE CORPUZ BONUS BSN, RN, CPHON
Provider Business Mailing Address
First Line : 11262 CAMPUS ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1727
Country : US
Telephone Number : 909-558-1000
Fax Number :
Provider Business Practice Location Address
First Line : 11262 CAMPUS ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1727
Country : US
Telephone Number : 909-558-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 03/27/2020

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