Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95008460 | CA |
NPI | 1003314774 |
---|---|
Provider Name | Christine Villarosa |
First Address | Eastvale, CA 92880-3152 |
Second Address | Riverside, CA 92506-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2018 |
Last Update Date | 29/01/2018 |