Provider Demographics
NPI:1942759220
Name:MENDRUN, MARIE BERNADETTE RAMOS (NP)
Entity Type:Individual
Prefix:
First Name:MARIE BERNADETTE
Middle Name:RAMOS
Last Name:MENDRUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6045 ROSEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0741
Mailing Address - Country:US
Mailing Address - Phone:626-428-1961
Mailing Address - Fax:
Practice Address - Street 1:5253 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4151
Practice Address - Country:US
Practice Address - Phone:909-464-2845
Practice Address - Fax:909-464-2848
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95005076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner