Provider Demographics
NPI:1992376859
Name:TOMASSIAN, JOHANA MARIELOS (RN)
Entity Type:Individual
Prefix:
First Name:JOHANA
Middle Name:MARIELOS
Last Name:TOMASSIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5766
Mailing Address - Country:US
Mailing Address - Phone:909-331-0106
Mailing Address - Fax:
Practice Address - Street 1:5549 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2068
Practice Address - Country:US
Practice Address - Phone:951-324-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765641163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine