Healthcare Provider Details

I. General information

NPI: 1083748222
Provider Name (Legal Business Name): NENITA AMPLAYO PERALTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NENITA AMPLAYO PERALTA RN

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10182 INDIANA AVE
RIVERSIDE CA
92503-5304
US

IV. Provider business mailing address

10182 INDIANA AVE
RIVERSIDE CA
92503-5304
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2400
  • Fax:
Mailing address:
  • Phone: 951-509-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN370581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: