Healthcare Provider Details

I. General information

NPI: 1518533744
Provider Name (Legal Business Name): ADRIANA VELEZ SHOFNER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAS TABLAS RD
TEMPLETON CA
93465-9704
US

IV. Provider business mailing address

197 HONEY WAY
TEMPLETON CA
93465-5415
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-3500
  • Fax:
Mailing address:
  • Phone: 805-400-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number673913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: