Healthcare Provider Details

I. General information

NPI: 1710221379
Provider Name (Legal Business Name): VICKI C SWEET RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34334 CALLE NARANJA
CAPISTRANO BEACH CA
92624-1058
US

IV. Provider business mailing address

34334 CALLE NARANJA
CAPISTRANO BEACH CA
92624-1058
US

V. Phone/Fax

Practice location:
  • Phone: 949-422-6026
  • Fax:
Mailing address:
  • Phone: 949-422-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number397142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: