Healthcare Provider Details

I. General information

NPI: 1417749904
Provider Name (Legal Business Name): JANICE DAYANNE CASTRO TALAVERA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 UNIVERSITY AVE
RIVERSIDE CA
92507-5263
US

IV. Provider business mailing address

31864 RAILROAD CANYON RD UNIT K
CANYON LAKE CA
92587-9498
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax: 360-462-5826
Mailing address:
  • Phone: 707-303-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: