Provider Demographics
NPI:1942028543
Name:BUENROSTRO, JUSTINA ROSE (BRITH DOULA)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:ROSE
Last Name:BUENROSTRO
Suffix:
Gender:F
Credentials:BRITH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 GROTTO LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5558
Mailing Address - Country:US
Mailing Address - Phone:909-201-4136
Mailing Address - Fax:
Practice Address - Street 1:6576 GROTTO LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5558
Practice Address - Country:US
Practice Address - Phone:909-201-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6980374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula