Provider Demographics
NPI:1811137938
Name:IMOOHI, BUCHI STELLA (FNP)
Entity type:Individual
Prefix:
First Name:BUCHI
Middle Name:STELLA
Last Name:IMOOHI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6367 PUMA PL
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-6513
Mailing Address - Country:US
Mailing Address - Phone:909-231-9242
Mailing Address - Fax:
Practice Address - Street 1:6367 PUMA PL
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91737-6513
Practice Address - Country:US
Practice Address - Phone:909-231-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health