Healthcare Provider Details

I. General information

NPI: 1568174381
Provider Name (Legal Business Name): BRENDA GUADALUPE RANGEL HERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 PARK CENTER DR
SANTEE CA
92071-6957
US

IV. Provider business mailing address

12371 SANTA CATALINA RD
VALLEY CENTER CA
92082-3702
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-5500
  • Fax: 619-596-5501
Mailing address:
  • Phone: 760-638-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95269015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: