Healthcare Provider Details

I. General information

NPI: 1306584404
Provider Name (Legal Business Name): DULCE ISELA MAYORAL CINCO APRN,MSN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST
BRAWLEY CA
92227-2630
US

IV. Provider business mailing address

640 LAS DUNAS ST
IMPERIAL CA
92251-8000
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-6471
  • Fax:
Mailing address:
  • Phone: 760-693-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: