Healthcare Provider Details

I. General information

NPI: 1871580670
Provider Name (Legal Business Name): RITA AWENDER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 S SAN JACINTO AVE STE A
SAN JACINTO CA
92583-5103
US

IV. Provider business mailing address

36779 CORDOBA TRL
BEAUMONT CA
92223-6332
US

V. Phone/Fax

Practice location:
  • Phone: 951-330-3100
  • Fax: 951-380-8596
Mailing address:
  • Phone: 909-712-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: