Individual
IRENE BACUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3330 CENTRE LAKE DR, ONTARIO, CA 91761-1211
(909) 974-4704
Mailing address
108 BREEZEWOOD ST, CORONA, CA 92879-1210
(951) 271-1985
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
625372
CA
Other
Enumeration date
06/21/2007
Last updated
07/08/2007
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