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General NPI Number Information
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NPI Number | 1174063317
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Entity Type | Organization
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Legal Business Name | IVITA, LLC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 590 RANCHO DE ORO RD
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City | ESCONDIDO
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State | CA
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Zip | 92026-3926
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Country | US
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Telephone | 888-322-6432
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Fax | 888-329-6432
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Provider Business Mailing Address
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Address Line | 590 RANCHO DE ORO RD
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City | ESCONDIDO
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State | CA
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Zip | 92026-3926
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Country | US
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Telephone | 888-322-6432
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Fax | 888-329-6432
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Authorized Official
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Title or Position | OWNER
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Name | MYRNA RAZO
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Credential | FNP-BC
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Telephone | 888-322-6432
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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 | 95002919
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License Number State | CA
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