Healthcare Provider Details

I. General information

NPI: 1861929994
Provider Name (Legal Business Name): GINA MYRNA GUILARTE-HAGEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGHLAND SPRINGS AVE STE 5
BEAUMONT CA
92223-2550
US

IV. Provider business mailing address

5430 ARLINGTON AVE
RIVERSIDE CA
92504
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-2342
  • Fax: 951-845-0084
Mailing address:
  • Phone: 951-689-2955
  • Fax: 951-689-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006356
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number462997
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number462997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: