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General NPI Number Information
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NPI Number | 1548040405
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Entity Type | Individual
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Provider Name | KATRINA CLARISSE PAREDES JUAT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 16143 KOKANEE RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1355
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Country | US
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Telephone | 760-242-6442
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Fax |
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Provider Business Mailing Address
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Address Line | 13389 ADLER ST
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City | VICTORVILLE
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State | CA
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Zip | 92392-5100
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Country | US
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Telephone | 760-486-1094
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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 | 2023089915
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License Number State | CA
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