Healthcare Provider Details

I. General information

NPI: 1013353549
Provider Name (Legal Business Name): CIELITO BLANCO CAPISTRANO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CIELITO BLANCO-CAPISTRANO MSN, FNP-C

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

IV. Provider business mailing address

7341 FALL WAY
EASTVALE CA
92880-1043
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-6335
  • Fax: 951-781-6365
Mailing address:
  • Phone: 951-601-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: