Provider Demographics
NPI:1083207252
Name:CALVERT, RIO MARIE A (FNP-C)
Entity Type:Individual
Prefix:
First Name:RIO MARIE
Middle Name:A
Last Name:CALVERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24721 KINGS POINTE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7455
Mailing Address - Country:US
Mailing Address - Phone:949-933-4943
Mailing Address - Fax:
Practice Address - Street 1:910 E BIRCH ST STE 350
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5848
Practice Address - Country:US
Practice Address - Phone:949-933-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515462363LF0000X
CA95018037363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily