Healthcare Provider Details

I. General information

NPI: 1083181754
Provider Name (Legal Business Name): ANNABELLE ABAYAN EDQUILANG RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28062 BAXTER RD
MURRIETA CA
92563-1401
US

IV. Provider business mailing address

45091 CALLE CUESTA
TEMECULA CA
92590-3341
US

V. Phone/Fax

Practice location:
  • Phone: 951-290-4000
  • Fax:
Mailing address:
  • Phone: 626-893-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number438425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: