Provider Demographics
NPI:1114220670
Name:ATIENZA, VIBETH (FNP)
Entity Type:Individual
Prefix:
First Name:VIBETH
Middle Name:
Last Name:ATIENZA
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:PO BOX 844074
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-4074
Mailing Address - Country:US
Mailing Address - Phone:775-329-0873
Mailing Address - Fax:
Practice Address - Street 1:5423 RENO CORPORATE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2250
Practice Address - Country:US
Practice Address - Phone:775-329-0873
Practice Address - Fax:775-329-1026
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV817653363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty