Healthcare Provider Details

I. General information

NPI: 1629995220
Provider Name (Legal Business Name): XIN REN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 ATLANTIC CITY AVE
GROVER BEACH CA
93433-1302
US

IV. Provider business mailing address

474 ATLANTIC CITY AVE
GROVER BEACH CA
93433-1302
US

V. Phone/Fax

Practice location:
  • Phone: 415-518-8919
  • Fax:
Mailing address:
  • Phone: 415-518-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberRN95382946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: