Individual
WURI TRIHASTUTI WIMBOPRASETYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RCP
Contact information
Practice address
27300 IRIS AVE, MORENO VALLEY, CA 92555-4802
(951) 243-0811
Mailing address
36853 BAY HILL DR, BEAUMONT, CA 92223-8015
(661) 210-6227
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
38700
CA
Other
Enumeration date
11/02/2018
Last updated
11/03/2018
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