Provider Demographics
NPI:1780335729
Name:BUELNA, NERISSA MERZA
Entity type:Individual
Prefix:MRS
First Name:NERISSA
Middle Name:MERZA
Last Name:BUELNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NERISSA
Other - Middle Name:MERZA
Other - Last Name:ADALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3475 N LUGO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3475 N LUGO AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2253
Practice Address - Country:US
Practice Address - Phone:909-681-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician