Healthcare Provider Details

I. General information

NPI: 1699142075
Provider Name (Legal Business Name): RHONDA MCGAUGHRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 ELIZABETH ST
RIVERSIDE CA
92506
US

IV. Provider business mailing address

3634 ELIZABETH ST
RIVERSIDE CA
92506-2506
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-0008
  • Fax: 951-788-0007
Mailing address:
  • Phone: 951-788-0008
  • Fax: 951-788-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: