Healthcare Provider Details

I. General information

NPI: 1871414946
Provider Name (Legal Business Name): RONEL VERTIDO GUARIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23637 BLACK OAK LN
MURRIETA CA
92562-6035
US

IV. Provider business mailing address

23637 BLACK OAK LN
MURRIETA CA
92562-6035
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-9448
  • Fax:
Mailing address:
  • Phone: 951-387-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN95437492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: