Healthcare Provider Details

I. General information

NPI: 1235218207
Provider Name (Legal Business Name): CAROLINA RASTROLLO DEL GALLEGO REGISTERED NURSE IV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM ROAD SUITE 6
RIVERSIDE CA
92503
US

IV. Provider business mailing address

PO BOX 7549
RIVERSIDE CA
92513
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-7380
  • Fax: 951-358-6311
Mailing address:
  • Phone: 951-358-7380
  • Fax: 951-358-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number546895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: