Basic Information
| Provider Information | |||||||||
| NPI: | 1922418003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERUMEN | ||||||||
| FirstName: | JANETT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 INLAND EMPIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094581350 | ||||||||
| FaxNumber: | 9095798149 | ||||||||
| Practice Location | |||||||||
| Address1: | 2940 INLAND EMPIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094581350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 103108 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.