Individual
KARISMA EDERLYN AGUSTIN EBORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 N CHINA LAKE BLVD STE 190, RIDGECREST, CA 93555-3131
(760) 499-3855
(760) 499-3870
Mailing address
1081 N CHINA LAKE BLVD, RIDGECREST, CA 93555-3130
(760) 499-3855
(760) 499-3870
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95194733
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
95012836
CA
Other
Enumeration date
10/21/2019
Last updated
05/17/2021
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