Healthcare Provider Details

I. General information

NPI: 1770341604
Provider Name (Legal Business Name): NILCRI TERORA MASSEY RCP-RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

1130 TENAYA ROAD
APPLEVALLEY CA
92308
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-8850
  • Fax:
Mailing address:
  • Phone: 760-882-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number42938
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number42938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: