Healthcare Provider Details

I. General information

NPI: 1174348007
Provider Name (Legal Business Name): LATOYA CALVIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

PO BOX 7123
NORCO CA
92860-8071
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3638
  • Fax: 951-784-3257
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95032150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: