Healthcare Provider Details

I. General information

NPI: 1871064220
Provider Name (Legal Business Name): RICARDO IVAN ALATRISTE BSN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S SHENANDOAH ST
LOS ANGELES CA
90034-2026
US

IV. Provider business mailing address

15701 SHERMAN WAY UNIT 7554
VAN NUYS CA
91409-8638
US

V. Phone/Fax

Practice location:
  • Phone: 747-254-0515
  • Fax:
Mailing address:
  • Phone: 818-309-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number041459379
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN72054
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number95149758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: