Desirae D'Shawn Bush

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-MAUCYV Issued in CA

Practice address

3576 Arlington Ave Ste 106
Riverside, CA 92506-3907

Phone

(951) 788-5905

Fax

(951) 788-5903

NPI assigned

Jan 20, 2023

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1942915111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3576 ARLINGTON AVE STE 106",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063907",
            "telephone_number": "951-788-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3576 ARLINGTON AVE STE 106",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063907",
            "telephone_number": "951-788-5905",
            "fax_number": "951-788-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "DESIRAE",
        "middle_name": "D'SHAWN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-20",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-MAUCYV",
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Denise Burt, LCSW
• Cheyenne Burton
• Taylor Busbee
• Jeremy Busch, D.P.M.
• Beverly Ann Bush
• Natalie Ariana Bush
• Sharnett Simone Bush, BHS
• Halee Bushman
• Taylor Bushong
• Mostafa Ismail Bushra

• Peer Specialist in Riverside, CA
• Providers in Riverside, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.