Healthcare Provider Details

I. General information

NPI: 1104138742
Provider Name (Legal Business Name): KARIN EVE COLUNGA MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 4TH ST
PERRIS CA
92570-2010
US

IV. Provider business mailing address

PO BOX 7270
MORENO VALLEY CA
92552-7270
US

V. Phone/Fax

Practice location:
  • Phone: 951-943-4751
  • Fax: 951-657-3522
Mailing address:
  • Phone: 951-486-5700
  • Fax: 951-486-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number526820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: