Healthcare Provider Details

I. General information

NPI: 1982482444
Provider Name (Legal Business Name): GUADALUPE RODARTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6848 MAGNOLIA AVE STE 125
RIVERSIDE CA
92506-2899
US

IV. Provider business mailing address

425 E FOOTHILL BLVD
RIALTO CA
92376-5153
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-9512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: