Provider Demographics
NPI:1730987645
Name:DIMPUDUS, DEVITA ELSA (PMHNP)
Entity type:Individual
Prefix:
First Name:DEVITA
Middle Name:ELSA
Last Name:DIMPUDUS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25925 BARTON ROAD UNIT 134
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:269-240-3486
Mailing Address - Fax:
Practice Address - Street 1:461 TENNESSEE ST STE C
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8161
Practice Address - Country:US
Practice Address - Phone:909-475-7371
Practice Address - Fax:855-233-7921
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95032404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health