Healthcare Provider Details

I. General information

NPI: 1093496200
Provider Name (Legal Business Name): RAULIN DADURAL FERIA APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23247 MAIN ST
CARSON CA
90745-5229
US

IV. Provider business mailing address

4055 REDWOOD AVE UNIT 104
LOS ANGELES CA
90066-5189
US

V. Phone/Fax

Practice location:
  • Phone: 310-429-0839
  • Fax:
Mailing address:
  • Phone: 323-229-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: