Healthcare Provider Details

I. General information

NPI: 1790050557
Provider Name (Legal Business Name): ANGELICA MARIA VERDUZCO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S CENTER ST
PIXLEY CA
93256-6000
US

IV. Provider business mailing address

981 CREEKVIEW PL
PORTERVILLE CA
93257-9064
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 559-310-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727407
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: