Provider Demographics
NPI:1770702961
Name:TERUKINA, RICHARD KIYOSHI JR (RN, NNP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KIYOSHI
Last Name:TERUKINA
Suffix:JR
Gender:M
Credentials:RN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:22856 MESA SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2630
Mailing Address - Country:US
Mailing Address - Phone:951-243-8789
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416121163WN0002X
CA11291363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Not Answered363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care