JUSTENE ANN ILOG

VISTA, CA
NPI1598451445
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CA  95025318)
Additional Taxonomies163WP0808X Registered Nurse, Psych/Mental Health
(Licence: CA  95219111)
Enumeration Date2023-04-13
Last Update Date2023-08-22
Business Address
JUSTENE ANN ILOG PMHNP
550 W VISTA WAY STE 103
VISTA, CA 92083-5735
Phone number: 760-295-8727
Mailing Address
JUSTENE ANN ILOG PMHNP
3927 MESA DR APT 105
OCEANSIDE, CA 92056-2624
Phone number: 951-768-0182