Individual
LUCYANA MAGRIETTA PANJAITAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
4500 BROCKTON AVE, RIVERSIDE, CA 92501-4090
(951) 276-2760
(951) 276-2960
Mailing address
4500 BROCKTON AVE, RIVERSIDE, CA 92501-4090
(951) 276-2760
(951) 276-2960
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95007651
CA
Other
Enumeration date
02/28/2019
Last updated
09/26/2023
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