Healthcare Provider Details

I. General information

NPI: 1619415122
Provider Name (Legal Business Name): KATIA NIKITA RIQUELME NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 NEWMAN AVE STE 101
HUNTINGTON BEACH CA
92647-7043
US

IV. Provider business mailing address

20251 SEALPOINT LN UNIT#204
HUNTINGTON BEACH CA
92646-8565
US

V. Phone/Fax

Practice location:
  • Phone: 949-432-4849
  • Fax: 770-502-6682
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95006034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: