Provider Demographics
NPI:1124711965
Name:MUSHILI, BUPE C (NP)
Entity type:Individual
Prefix:
First Name:BUPE
Middle Name:C
Last Name:MUSHILI
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Gender:M
Credentials:NP
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Mailing Address - Street 1:3400 INLAND EMPIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5577
Mailing Address - Country:US
Mailing Address - Phone:909-870-0160
Mailing Address - Fax:909-870-0161
Practice Address - Street 1:415 W ROUTE 66 STE 202
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:626-963-9543
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2024-04-04
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Provider Licenses
StateLicense IDTaxonomies
CA95025342363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health