Healthcare Provider Details

I. General information

NPI: 1174432520
Provider Name (Legal Business Name): KHAREN FAITH QUINO EGENIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E ALESSANDRO BLVD
RIVERSIDE CA
92508-6071
US

IV. Provider business mailing address

1173 CONESTOGA ST
CORONA CA
92881-8619
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: