Healthcare Provider Details

I. General information

NPI: 1295445807
Provider Name (Legal Business Name): JEAN GREY LABRADOR KENT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEAN TARAH BENAVIDES LABRADOR RN

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 ELIZABETH ST
RIVERSIDE CA
92506-2506
US

IV. Provider business mailing address

3634 ELIZABETH ST
RIVERSIDE CA
92506-2506
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-0008
  • Fax: 951-383-4434
Mailing address:
  • Phone: 951-788-0008
  • Fax: 951-383-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95217399
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: