Healthcare Provider Details

I. General information

NPI: 1841907235
Provider Name (Legal Business Name): LOURDES RUBALCAVA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

41229 MAYBERRY AVE
HEMET CA
92544-6342
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax:
Mailing address:
  • Phone: 310-717-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number671716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: