Healthcare Provider Details

I. General information

NPI: 1285341743
Provider Name (Legal Business Name): RIZA MORALES TIGLAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 01/01/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAISER 975 SERENO DR
VALLEJO CA
95687
US

IV. Provider business mailing address

975 SERENO DR
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1000
  • Fax:
Mailing address:
  • Phone: 707-651-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95023150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: