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General NPI Number Information
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NPI Number | 1144689175
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Entity Type | Individual
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Provider Name | ROWENA SAN JUAN DACANAY-HERMAN N.P.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 2457 TRACE RD
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City | SPRING VALLEY
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State | CA
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Zip | 91978-1928
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Country | US
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Telephone | 619-772-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 2457 TRACE RD
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City | SPRING VALLEY
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State | CA
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Zip | 91978-1928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22378
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License Number State | CA
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