Individual
RAINER GUERRA BANSUAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3102 E HIGHLAND AVE, PATTON, CA 92369-7813
(909) 815-0965
Mailing address
17060 ESTORIL ST, CHINO HILLS, CA 91709-4105
(909) 815-0965
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
207QA51021
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A510212
—
CA
Enumeration date
08/29/2006
Last updated
04/18/2021
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