Basic Information
| Provider Information | |||||||||
| NPI: | 1811324320 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BENTUM | ||||||||
| FirstName: | ERNEST | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1532 SAN BERNARDINO AVE | ||||||||
| Address2: | STE A2 | ||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917673559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1532 SAN BERNARDINO AVE | ||||||||
| Address2: | STE A2 | ||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917673559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2013 | ||||||||
| LastUpdateDate: | 04/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 23495 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.