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General NPI Number Information
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NPI Number | 1821618638
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Entity Type | Individual
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Provider Name | RODOLFO JARAVATA HANSON FNP-C
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 29910 MURRIETA HOT SPRINGS RD., STE G-505
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City | MURRIETA
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State | CA
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Zip | 92563-3815
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Country | US
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Telephone | 562-390-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 29910 MURRIETA HOT SPRINGS RD., STE G-505
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City | MURRIETA
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State | CA
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Zip | 92563-3815
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Country | US
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Telephone | 562-390-6744
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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 | 95014394
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License Number State | CA
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