=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609681667
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBINA VAGHELA FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2025
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23211 HAWTHORNE BLVD STE 200A
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-3769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-387-5183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23211 HAWTHORNE BLVD STE 200A
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-3769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-387-5183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 95029393
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------