STUDENT (NPI# 1174079347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174079347 |
| Entity Type | Organization |
| Organization Name | STUDENT |
| Practice Address |
1640 Juanita Ln Redlands CA 92373-7142 |
| Practice Telephone | 9517568989 |
| Mailing Telephone | 9517568989 |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |
| Authorized Official Name | MR. CULLEN MACK (STUDENT) |
| Authorized Official Telephone | 9517568989 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285992909 | Student | Student in an Organized Health Care Education/Training Program | 16554 N Meadow Ln, Petersburg, IL 62675-6786 | 2012-05-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STUDENT & BORROWER SERVICES | 205 13th St Ne, Washington, DC 20002-6323 |
| Virginia Business Entities | STUDENT & YOUTH TRAVEL ASSOCIATION | 2231 Crystal Drive, Suite 204, Arlington, Virginia 22201 |
| Washington State Corporations | STUDENT 1ST ATHLETE 2ND LLC | 113 Cherry St # 93484, Seattle, WA 98104-2205 |
| Oregon Corporations, Companies and Business Names | STUDENT ACADEMIC AND ACTIVITY SERVICES LLC | 18905 Couch Market Rd, Bend, OR 97703 |
| New York State Corporations | STUDENT ACADEMIC SERVICES 360 NYC LLC | P.o. Box 40411, Glen Oaks, Ny 11004 |
| Virginia Business Entities | Student Account Management Services LLC | 2130 Chester Ave Ste 101, Bakersfield, California 93301 |
| Connecticut Business Registrations | Student Account Management Services, LLC | 2130 Chester Ave., Ste. 101, Bakersfield, CA 93301 |
| Iowa Business Entities | STUDENT ACCOUNT MANAGEMENT SERVICES, LLC | 2130 Chester Ave, Suite 101, Bakersfield, CA 93301 |
| New York State Corporations | STUDENT ACCOUNT MANAGEMENT SERVICES, LLC | 2130 Chester Ave., Ste. 101, Bakersfield, California 93301 |
| Oregon Corporations, Companies and Business Names | STUDENT ACCOUNT MANAGEMENT SERVICES, LLC | 2611 F Street, Bakersfield, CA 93301 |
| Street Address |
1640 JUANITA LN |
| City | REDLANDS |
| State | CA |
| Zip Code | 92373-7142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508473422 | Mindfulness Counseling Services | Marriage & Family Therapist | 101 E. Redlands, Suite 170a, Redlands, CA 92373 | 2020-09-24 |
| 1710596721 | Vandna Mittal | Counselor | 26967 Beamount Avenue, 1020 Coronado Drive, Redlands, CA 92373 | 2020-07-26 |
| 1164062345 | Sara Bencoe | Nurse Practitioner | 101 E. Redlands Blvd. Ste. 106, Redlands, CA 92373 | 2020-01-15 |
| 1033604103 | John Duane Wuchenich | Anesthesiology | 451 Summit Avenue, Redlands, CA 92373 | 2018-06-29 |
| 1013401074 | Adept Hospice Care | Hospice Care, Community Based | 515 New Jersey St., Suite G, Redlands, CA 92373 | 2018-06-21 |
| 1134616121 | Rodrigo Robles | Student in an Organized Health Care Education/Training Program | 26001 Redlands Blvd ., 2nd Floor, 2d 301, Redlands, CA 92373 | 2018-04-16 |
| 1760987614 | Redlands Endodontics | Dentist | 245 Terracina Blvd Suite 207 B, Redlands, CA 92373 | 2018-03-23 |
| 1487164166 | Tyler Stafford | Behavioral Analyst | 1467 Ford St. Suite 104, Redlands, CA 92373 | 2017-10-06 |
| 1083131486 | Shannon Palmowski | Behavioral Analyst | Institute for Behavioral Health, 1041 Alabama Ave, Redlands, CA 92373 | 2017-08-25 |
| 1275062622 | Erim Sarbuland | Marriage & Family Therapist | 101 East Redlands Boulevard, Suites #215, Redlands, CA 92373 | 2017-06-08 |
| Find all providers in zip 92373 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104434893 | Riley Pyne Warner | Physician Assistant | 92 Kansas St Apt F23, Redlands, CA 92373-5429 | 2020-07-19 |
| 1710543194 | Tiffany Darlene Mendoza | Physician Assistant | 93 Kansas St Apt 605, Redlands, CA 92373-1476 | 2019-05-11 |
| 1750861951 | Jordan David Giesler | Physician Assistant | 75 Price St Apt A, Redlands, CA 92373-1426 | 2018-08-16 |
| 1952889800 | Megan Straw | Physician Assistant | 1754 Somerset Ln, Redlands, CA 92374-5561 | 2018-08-02 |
| 1497260772 | Annie Wai-chee Li | Physician Assistant | 255 Terracina Blvd Ste 101a, Redlands, CA 92373-4870 | 2017-12-07 |
| 1942655303 | Jeff Del Real | Physician Assistant | 118 E Cypress Ave, Redlands, CA 92373-6035 | 2016-05-03 |
| 1639540131 | Travis Taggart | Physician Assistant | 808 Rachel Ct, Redlands, CA 92373-4563 | 2015-10-09 |
| 1740659994 | Aurora Casas Ledezma | Physician Assistant | 1969 Orange Tree Ln Ste B, Redlands, CA 92374-0114 | 2015-09-17 |
| 1629499322 | Pamela Denese Moore | Physician Assistant | 1716 Allison Way, Redlands, CA 92373-7436 | 2013-12-23 |
| 1609159615 | Rebecca R.m. Ware | Physician Assistant | 255 Terracina Blvd., Suite 101a, Redlands, CA 92373 | 2011-09-26 |
| Find all providers in REDLANDS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.