Provider Demographics
NPI:1679164776
Name:LUSTIG, RHONDA (RN BSN)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:LUSTIG
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73438 FOXTAIL LN
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-6832
Mailing Address - Country:US
Mailing Address - Phone:856-237-3068
Mailing Address - Fax:
Practice Address - Street 1:29610 RANCHO CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5283
Practice Address - Country:US
Practice Address - Phone:951-699-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000228741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000228741OtherDEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS