Healthcare Provider Details

I. General information

NPI: 1902279599
Provider Name (Legal Business Name): RHEALYNN SISON NOFUENTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR #408
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR #408
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-1174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002795
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95002795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: