Provider Demographics
NPI:1861929994
Name:GUILARTE-HAGEN, GINA MYRNA (FNP)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MYRNA
Last Name:GUILARTE-HAGEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504
Mailing Address - Country:US
Mailing Address - Phone:951-689-2955
Mailing Address - Fax:951-689-2477
Practice Address - Street 1:701 HIGHLAND SPRINGS AVE STE 5
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2550
Practice Address - Country:US
Practice Address - Phone:951-845-2342
Practice Address - Fax:951-845-0084
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462997163W00000X, 207R00000X
CA95006356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine