Provider Demographics
NPI:1619568052
Name:PRYOR, NIMFA SALVADORA
Entity Type:Individual
Prefix:
First Name:NIMFA
Middle Name:SALVADORA
Last Name:PRYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38416 GARWAY DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5921
Mailing Address - Country:US
Mailing Address - Phone:510-579-8358
Mailing Address - Fax:
Practice Address - Street 1:38416 GARWAY DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5921
Practice Address - Country:US
Practice Address - Phone:510-579-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070651372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion