Healthcare Provider Details

I. General information

NPI: 1306205208
Provider Name (Legal Business Name): LORENA HERMINIA RUIZ AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORENA HERMINIA RIVAS

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

27525 SUNRAY CT
MURRIETA CA
92562-2816
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax:
Mailing address:
  • Phone: 951-788-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95003658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: