Healthcare Provider Details

I. General information

NPI: 1992492250
Provider Name (Legal Business Name): AVERYL NYRA D NARVASA RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25828 REDLANDS BLVD STE 101
REDLANDS CA
92373-8451
US

IV. Provider business mailing address

4484 JONES AVE
RIVERSIDE CA
92505-2806
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-0964
  • Fax:
Mailing address:
  • Phone: 951-743-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2358792
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95033300
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95397686
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2358792
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: