Healthcare Provider Details

I. General information

NPI: 1013947910
Provider Name (Legal Business Name): ROSAFEL R. ADRIANO-NOGRA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/03/2024
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21250 STEVENS CREEK BLVD.
CUPERTINO CA
95014-5913
US

IV. Provider business mailing address

613 APPIAN WAY
UNION CITY CA
94587-9998
US

V. Phone/Fax

Practice location:
  • Phone: 408-864-8732
  • Fax: 408-864-8983
Mailing address:
  • Phone: 408-701-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number580191
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15930
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number580191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: