Healthcare Provider Details

I. General information

NPI: 1275102436
Provider Name (Legal Business Name): ANDREA ROSE ARISTA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E FLORIDA AVE
HEMET CA
92543-4335
US

IV. Provider business mailing address

601 E FLORIDA AVE
HEMET CA
92543-4335
US

V. Phone/Fax

Practice location:
  • Phone: 951-391-1470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number718828
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1630810925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: