MEDICARE: MRS. ANITA CORINA ADORADOR FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	11380NP	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11380NP	OTHER	CA	NURSE PRACTIONER

General Provider Information

NPI Number	:	1780654624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITA CORINA ADORADOR FNP

Provider Business Mailing Address
First Line	:	802 W COLTON AVE STE E
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2905
Country	:	US
Telephone Number	:	909-335-5799
Fax Number	:	909-793-6614

Provider Business Practice Location Address
First Line	:	802 W COLTON AVE STE E
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2905
Country	:	US
Telephone Number	:	909-335-5799
Fax Number	:	909-793-6614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/28/2016

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