Provider Demographics
NPI:1518783034
Name:SERVIN, CHARO GUADALUPE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:CHARO
Middle Name:GUADALUPE
Last Name:SERVIN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N TIPPECANOE AVE UNIT 124
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-4021
Mailing Address - Country:US
Mailing Address - Phone:626-660-5897
Mailing Address - Fax:
Practice Address - Street 1:200 OCEANGATE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4317
Practice Address - Country:US
Practice Address - Phone:562-435-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-30
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95154137163W00000X
CA95031136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse