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General NPI Number Information
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NPI Number | 1912608563
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Entity Type | Individual
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Provider Name | OLIVEA DEGRANDE-EQUIHUA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 17055 VAN BUREN BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92504-5923
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Country | US
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Telephone | 951-780-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 3248 MOHAWK TRL
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City | RIVERSIDE
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State | CA
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Zip | 92503-5458
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Country | US
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Telephone | 951-742-9829
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 109929
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License Number State | CA
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