Jonathan Wibisono, NP
NPI #1992158653 in Beaumont, California
Provider Information
- NPI Number
- 1992158653
- Entity Type
- Individual
- Name
- Jonathan Wibisono, NP
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Nurse Practitioner
- Credential
- NP
- Enumeration Date
- Jul 18, 2016
- Last Updated
- Jul 18, 2016
Practice Location
- Address
- 851 E 6TH ST
- Address 2
- SUITE B-4
- City
- Beaumont
- State
- California
- ZIP Code
- 92223-2340
- Phone
- (951) 845-2294
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
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