Individual
WENCYLITO ALIVIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
210 W SAN BERNARDINO RD, COVINA, CA 91723-1515
(626) 938-7650
Mailing address
4336 QUIROGA LN, FONTANA, CA 92336-4771
(818) 913-4896
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
95236780
CA
Other
Enumeration date
07/28/2023
Last updated
07/28/2023
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