Healthcare Provider Details

I. General information

NPI: 1033632294
Provider Name (Legal Business Name): VANESSA AVILA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

IV. Provider business mailing address

PO BOX 79466
CORONA CA
92877-0182
US

V. Phone/Fax

Practice location:
  • Phone: 888-743-7526
  • Fax:
Mailing address:
  • Phone: 951-858-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95122637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: