Healthcare Provider Details

I. General information

NPI: 1871245688
Provider Name (Legal Business Name): RICHARD ERIC OFFEMARIA ATANGAN FNP-BC, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR STE 208
RIVERSIDE CA
92505-3071
US

IV. Provider business mailing address

3660 PARK SIERRA DR STE 203
RIVERSIDE CA
92505-3071
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-2800
  • Fax: 951-687-7290
Mailing address:
  • Phone: 951-687-3400
  • Fax: 951-687-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: