Basic Information
| Provider Information | |||||||||
| NPI: | 1730854217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUACHINO | ||||||||
| FirstName: | ROLLENA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406 | ||||||||
| Address2: | |||||||||
| City: | PAUMA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920610406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 50100 GOLSH RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CENTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920825338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2021 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | PHN560609 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.