Healthcare Provider Details

I. General information

NPI: 1184165151
Provider Name (Legal Business Name): DAISY JASMIN TAPIA I LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/30/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 PALM AVE
RIVERSIDE CA
92501-4012
US

IV. Provider business mailing address

4750 PALM AVE
RIVERSIDE CA
92501-4012
US

V. Phone/Fax

Practice location:
  • Phone: 800-300-7326
  • Fax:
Mailing address:
  • Phone: 951-686-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number274947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: