Individual
SUSAN TAVITAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED NURSE
Contact information
Practice address
7440 MARILYN DR, CORONA, CA 92881-4226
(714) 488-9091
Mailing address
7440 MARILYN DR, CORONA, CA 92881-4226
(714) 488-9091
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
VN 166898
CA
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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