Provider Demographics
NPI:1417344706
Name:INDENDI, STEVEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:INDENDI
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18312 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4160
Mailing Address - Country:US
Mailing Address - Phone:909-301-7570
Mailing Address - Fax:
Practice Address - Street 1:18312 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4160
Practice Address - Country:US
Practice Address - Phone:909-301-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA780981163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice