Healthcare Provider Details

I. General information

NPI: 1598924847
Provider Name (Legal Business Name): RAYDOLFO ABARO APRECIO JR. SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 CHICKADEE CIR
RIVERSIDE CA
92507-1223
US

IV. Provider business mailing address

26295 SNOWDEN AVE
REDLANDS CA
92374-4503
US

V. Phone/Fax

Practice location:
  • Phone: 951-369-5071
  • Fax:
Mailing address:
  • Phone: 909-838-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: