Provider Demographics
NPI:1356422935
Name:NENITA F. ITURZAETA M.D., INC.
Entity type:Organization
Organization Name:NENITA F. ITURZAETA M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NENITA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ITURZAETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-886-7576
Mailing Address - Street 1:850 W HIGHLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3855
Mailing Address - Country:US
Mailing Address - Phone:909-886-7576
Mailing Address - Fax:
Practice Address - Street 1:850 W HIGHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3855
Practice Address - Country:US
Practice Address - Phone:909-886-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366593618OtherNPI