Healthcare Provider Details

I. General information

NPI: 1366598633
Provider Name (Legal Business Name): RITA ALICIA SHIREY RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 WAKE AVE SUITE B
EL CENTRO CA
92243-9490
US

IV. Provider business mailing address

PO BOX 628
SEELEY CA
92273-0628
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-2257
  • Fax: 760-352-7853
Mailing address:
  • Phone: 760-352-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN257179
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN257179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: