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Organization
ANTEDAR PSYCHIATRIC NURSING PROFESSIONAL SERVICES, INC
Active
Organization
ANTEDAR PSYCHIATRIC NURSING PROFESSIONAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARIASA KANABOLO NP (CEO)
(951) 236-9430
Entity
Organization
Contact information
Practice address
6860 BROCKTON AVE, RIVERSIDE, CA 92506-3821
(951) 236-9430
Mailing address
PO BOX 51927, RIVERSIDE, CA 92517-2927
(951) 236-9430
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/28/2023
Last updated
12/29/2023
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