Healthcare Provider Details

I. General information

NPI: 1497299549
Provider Name (Legal Business Name): MARIA SOLEDAD ASCENCIO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE # 301
RIVERSIDE CA
92506-0102
US

IV. Provider business mailing address

4646 BROCKTON AVE #301
RIVERSIDE CA
92506-0102
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-6905
  • Fax: 951-682-6905
Mailing address:
  • Phone: 951-682-6900
  • Fax: 951-682-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: