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STUDENT
NPI 1174079347
Physician Assistant in Redlands, CA

Active since August 28, 2016
1640 JUANITA LN, REDLANDS, CA 92373(951) 756-8989 Get Directions Write a Review

NPPES record last updated: August 28, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Student NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STUDENT (NPI 1174079347) is a healthcare organization registered as a physician assistant in Redlands, California and active in the NPI registry since August 2016. The organization lists Cullen Mack, Student, as its authorized official.

NPPES Registry Identity

NPI1174079347
Entity TypeOrganization
Primary Taxonomy363A00000X
Legal Business NameSTUDENT
Location Address1640 JUANITA LNRedlands, CA 92373-7142
Mailing Address1640 Juanita LnRedlands, CA 92373-7142 · (951) 756-8989
Phone(951) 756-8989
Organization SubpartNo
Authorized OfficialCullen MackStudent · (951) 756-8989
Enumeration DateAugust 28, 2016
✔ NPI 1174079347 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1640 JUANITA LN, Redlands, CA 92373
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Student's NPI number?

The NPI number for Student is 1174079347. It was assigned to this organization in the NPPES registry on August 28, 2016.

Where is Student located?

Student is located at 1640 Juanita Ln, Redlands, CA 92373. The listed phone number is (951) 756-8989.

What is Student's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Student was last updated on August 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.