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JUSAC ARIZTHIAN SURYANATA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
3308 CAROLYN CIR, OCEANSIDE, CA 92054-3844
(760) 658-4405
Mailing address
3308 CAROLYN CIR, OCEANSIDE, CA 92054-3844
(760) 658-4405

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
95166131
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95031637
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95031637
CALIFORNIA BRN
CA
01
95166131
CALIFORNIA BRN
CA
Enumeration date
12/20/2023
Last updated
04/22/2025
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