Healthcare Provider Details

I. General information

NPI: 1942913348
Provider Name (Legal Business Name): BLANCA LEMUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD STE 3
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

PO BOX 252
WINCHESTER CA
92596-0252
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-8320
  • Fax:
Mailing address:
  • Phone: 951-623-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number711361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: