Individual
NELSON JAVIER MARAVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 788-3000
Mailing address
65792 ESTRELLA AVE, DESERT HOT SPRINGS, CA 92240-3514
(760) 880-0408
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
95001423
CA
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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