Provider Demographics
NPI:1518605237
Name:EUSEBIO, JOHN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:EUSEBIO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:JOHN MICHAEL FRANCIS
Other - Middle Name:
Other - Last Name:EUSEBIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2520 S BON VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6110
Mailing Address - Country:US
Mailing Address - Phone:909-731-0970
Mailing Address - Fax:
Practice Address - Street 1:4500 BROCKTON AVE STE 107
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4006
Practice Address - Country:US
Practice Address - Phone:951-276-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily