Healthcare Provider Details

I. General information

NPI: 1588892889
Provider Name (Legal Business Name): ANA CECILIA VARGAS-VILLENA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROCKTON AVE
RIVERSIDE CA
92501-4068
US

IV. Provider business mailing address

25971 HINCKLEY ST
LOMA LINDA CA
92354-3947
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-8020
  • Fax:
Mailing address:
  • Phone: 909-478-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP11321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: