Individual
ELYSSA BANGUNAN RIVERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
8700 BEVERLY BLVD, WEST HOLLYWOOD, CA 90048-1804
(310) 423-6276
Mailing address
8700 BEVERLY BLVD, WEST HOLLYWOOD, CA 90048-1804
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95008275
CA
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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