Healthcare Provider Details

I. General information

NPI: 1134054224
Provider Name (Legal Business Name): MRS. ADIA ADRIANA WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 13TH ST BLDG 193
IMPERIAL BEACH CA
91932-3798
US

IV. Provider business mailing address

1498 13TH ST BLDG 193
IMPERIAL BEACH CA
91932-3798
US

V. Phone/Fax

Practice location:
  • Phone: 915-205-2480
  • Fax:
Mailing address:
  • Phone: 915-205-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: