Individual
STP JOURNEY GULLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4100 LATHAM ST STE E, RIVERSIDE, CA 92501-1733
(951) 393-1333
Mailing address
6400 SHAFER CT STE 700, ROSEMONT, IL 60018-4989
(346) 376-1702
(224) 532-2780
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
95020502
CA
Other
Enumeration date
05/10/2022
Last updated
10/20/2022
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