Basic Information
| Provider Information | |||||||||
| NPI: | 1194044586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVILA | ||||||||
| FirstName: | ROSALINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CUEVAS | ||||||||
| OtherFirstName: | ROSALINA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1615 BUNKER HILL WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939066013 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD | ||||||||
| Address2: | BLDG 200, FLOOR 1, SUITE 105 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317698660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2010 | ||||||||
| LastUpdateDate: | 05/25/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 418178 | CA | Y | Nursing Service Providers | Registered Nurse | 363L00000X | 6191 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | ZZZ02040Z | 01 | CA | MEDICARE GRP | OTHER | FHC70125F | 05 | CA | MEDICAID |