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Jusac Suryanata, RN
Psychiatric/Mental Health Registered Nurse in Poway, California
NPI 1124897046

Jusac Suryanata is a Psychiatric/Mental Health Registered Nurse based in Oceanside, CA and is specialized in Psychiatric/Mental Health. Jusac Suryanata practices in Poway, CA and has the professional credentials of RN. The NPI Number for Jusac Suryanata is 1124897046 and holds a License No. 95166131 (California).

The current practice location address for Jusac Suryanata is 15615 Pomerado Rd, Poway, CA and can be reached out via phone at 858-613-4340.

Location: 15615 Pomerado Rd, Poway, CA, 92054-3844
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Provider Profile Details
NPI Number
1124897046
Provider Name
Jusac Suryanata
Credential
RN
Provider Entity Type
Individual
Gender
Male
Address
15615 Pomerado Rd, Poway, CA, 92054-3844
Phone Number
858-613-4340
Fax Number
Provider Enumeration Date
12/20/2023
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
95166131 01 CA CALIFORNIA BRN
institution
Provider Business Practice Location Address Details
Address
15615 Pomerado Rd
City
State
Zip
92064-2405
Phone Number
858-613-4340
Fax Number
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Provider Business Mailing Address Details
Address
15615 Pomerado Rd
City
State
Zip
92064-2405
Phone Number
858-613-4340
Fax Number
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Provider's Taxonomy Details 1
Type
Nursing Service Providers
Classification
Registered Nurse
Speciality
Psychiatric/Mental Health
Taxonomy
License No.
95166131 (California)
Definition
Definition to come...
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