Cornelio Emmanuel Bengzon Rustia, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95007135 Issued in CA

Practice address

1324 Willowstone CT
San Jacinto, CA 92582-4247

Phone

(951) 665-3264

NPI assigned

Dec 12, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: crustia92686@direct.llu.edu
• Direct secure messaging: cornelio.rustia.p1@direct.chsica.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1033624036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 WILLOWSTONE CT",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925824247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 WILLOWSTONE CT",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925824247",
            "telephone_number": "951-665-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTIA",
        "first_name": "CORNELIO EMMANUEL",
        "middle_name": "BENGZON",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-12",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN534950",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95007135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve Desean Ross
• Quinten Gerald Rowley
• Karla Ruiz Miranda
• Dezaray Ruiz
• Tiarra J Rushing
• Justin Ryan, PPS
• Nick Edward Ryan, LMFT
• Sayyed Dhiaaddin Saadi, PHD
• Genesey Salcedo
• Jasmine Salenga, LCSW

• Family Nurse Practitioner in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.