| Doctor Name: | JOYCE DEVINA KUSUMA |
| NPI Number: | 1144536145 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 19163 |
| Business Practice Address: | 370 Summit Blvd Big Bear Lake, CA - 92315 |
| Business Phone Number: | 9098788264 |
| Business Fax Number: | |
| Mailing Address: | 370 Summit Blvd, BIG BEAR LAKE |
| State: | CA |
| Postal Code: | 92315 |
| Phone Number: | 9098025574 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2010 |
| NPI Last Update Date: | 04/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 19163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |