Provider Demographics
NPI:1548441579
Name:VASQUEZ, LIDIA RIVERA (RN NP-C)
Entity type:Individual
Prefix:MS
First Name:LIDIA
Middle Name:RIVERA
Last Name:VASQUEZ
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Gender:F
Credentials:RN NP-C
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Mailing Address - Street 1:3660 PARK SIERRA DR
Mailing Address - Street 2:STE 208
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:310-638-0533
Mailing Address - Fax:310-638-9171
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:STE 208
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3071
Practice Address - Country:US
Practice Address - Phone:951-687-3400
Practice Address - Fax:951-687-7630
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-04-05
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Provider Licenses
StateLicense IDTaxonomies
CA95000887363L00000X
CA477882163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health