Healthcare Provider Details

I. General information

NPI: 1841471877
Provider Name (Legal Business Name): TESSA PASCUAL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 MISSION BLVD
RUBIDOUX CA
92509-4624
US

IV. Provider business mailing address

4065 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-5338
  • Fax: 951-955-5329
Mailing address:
  • Phone: 951-955-5338
  • Fax: 951-955-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number630077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: