Basic Information
| Provider Information | |||||||||
| NPI: | 1003012691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACUS | ||||||||
| FirstName: | IRENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 BREEZEWOOD ST | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928791210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512711985 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3330 CENTRE LAKE DR | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917611211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099744704 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 625372 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.