Individual
HARIS BASRI SINAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14677 MERRILL AVENUE, FONTA, CA 92335
(951) 643-2340
Mailing address
12440 TAMARISK DR, RANCHO CUCAMONGA, CA 91739-1517
(909) 972-5349
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN214075
CA
Other
Enumeration date
10/25/2019
Last updated
10/25/2019
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