Healthcare Provider Details

I. General information

NPI: 1164183943
Provider Name (Legal Business Name): ROWENA ARAGON CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROWENA CABANSAG RAMEL

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 LA SIERRA AVE
RIVERSIDE CA
92505-2612
US

IV. Provider business mailing address

11430 DOVERWOOD DR
RIVERSIDE CA
92505
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-4196
  • Fax:
Mailing address:
  • Phone: 951-312-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number168963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: