Basic Information
| Provider Information | |||||||||
| NPI: | 1750548731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURROW | ||||||||
| FirstName: | RETHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41002 COUNTY CENTER DR | ||||||||
| Address2: | #320 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925916027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006355 | ||||||||
| FaxNumber: | 9516006365 | ||||||||
| Practice Location | |||||||||
| Address1: | 41002 COUNTY CENTER DR | ||||||||
| Address2: | #320 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925916027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006355 | ||||||||
| FaxNumber: | 9516006365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 361478 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.