CorpID/LocID

Practitioner List:

 TAVARUA MEDICAL REHABILITATION SERVICES D.B.A. AZUSA MEDICAL AND MENTAL HEALTH SERVICES
 474 South Citrus Avenue,
 Azusa, CA  91702

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First NameLast NamePractitioner TypeNPICalifornia License NumberCalifornia License TypeCultural Competence Training
IVELISSEJOURDAIN Licensed Eligible Practitioner working under the supervision of a Licensed Clinician 1295406528VN707796 Yes
MONIQUEWHITE-DOMINGUEZ Physician (MD or DO) 133645790220A11372Medical Board of California (MD or DO)Yes
MONIVIRINSON Physician (MD or DO) 1699751776A85627Medical Board of California (MD or DO)Yes
RANDIWILEY Licensed Eligible Practitioner working under the supervision of a Licensed Clinician 1043872351VN685417 Yes