Provider Demographics
NPI:1467220442
Name:BUPE MUSHILI PMHNP NURSING INC
Entity Type:Organization
Organization Name:BUPE MUSHILI PMHNP NURSING INC
Other - Org Name:BUPE MUSHILI PMHNP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BUPE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUSHILI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:909-870-0160
Mailing Address - Street 1:3400 INLAND EMPIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5577
Mailing Address - Country:US
Mailing Address - Phone:909-870-0160
Mailing Address - Fax:909-870-0161
Practice Address - Street 1:415 W ROUTE 66 STE 202
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:626-963-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty