Individual
REDENTOR BACANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7000 BOULDER AVE, HIGHLAND, CA 92346-3348
(909) 403-6499
Mailing address
7000 BOULDER AVE, HIGHLAND, CA 92346-3348
(909) 403-6499
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
62670
CA
363AM0700X
Medical Physician Assistant
Primary
814
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487725693
—
NV
01
—
P01257618
RAILROAD MEDICARE
NV
Enumeration date
11/10/2006
Last updated
03/20/2025
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