Provider Demographics
NPI:1467731042
Name:BAQUIR, ABE RUBEN BERNARDO (FNP)
Entity Type:Individual
Prefix:
First Name:ABE RUBEN
Middle Name:BERNARDO
Last Name:BAQUIR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6405
Mailing Address - Country:US
Mailing Address - Phone:310-513-0987
Mailing Address - Fax:
Practice Address - Street 1:994 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3816
Practice Address - Country:US
Practice Address - Phone:310-671-2420
Practice Address - Fax:310-330-5670
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily