Provider Demographics
NPI:1285489864
Name:CHUA, BETTINA DENNISE (FNP-C)
Entity type:Individual
Prefix:
First Name:BETTINA DENNISE
Middle Name:
Last Name:CHUA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 AQUEDUCT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2038
Mailing Address - Country:US
Mailing Address - Phone:747-287-9598
Mailing Address - Fax:
Practice Address - Street 1:710 S CENTRAL AVE STE 330
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4647
Practice Address - Country:US
Practice Address - Phone:818-500-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily