Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Student

Organization Physician Assistant · NPI 1174079347

Student is a Physician Assistant in Redlands, California. Registered with an NPI since 2016.

In the registry since
2016

Practice location Address checks out

1640 Juanita Ln
Redlands, CA 92373-7142
Phone: (951) 756-8989
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1174079347
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Cullen Mack — Student · (951) 756-8989
NPI enumeratedAugust 28, 2016
Last updated in NPPESAugust 28, 2016
Mailing address1640 Juanita Ln, Redlands, CA 92373-7142

Other providers in Redlands