Healthcare Provider Details

I. General information

NPI: 1962368969
Provider Name (Legal Business Name): NEQUAYLE PETES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 HARRISON ST # 92503
RIVERSIDE CA
92503-3523
US

IV. Provider business mailing address

3933 HARRISON ST # 92503
RIVERSIDE CA
92503-3523
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number745582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: