Individual
EDITH KAWIRA VICTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13461 SHADY KNOLL DR, EASTVALE, CA 92880-3199
(909) 275-5038
Mailing address
13461 SHADY KNOLL DR, EASTVALE, CA 92880-3199
(909) 275-5038
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN279001
CA
Other
Enumeration date
04/14/2019
Last updated
04/14/2019
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