Provider Demographics
NPI:1720558067
Name:TRYON, RHONDA E
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:E
Last Name:TRYON
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 1:11424 CHAMBERLAINE WAY STE 11
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-2869
Mailing Address - Country:US
Mailing Address - Phone:760-246-0934
Mailing Address - Fax:
Practice Address - Street 1:11424 CHAMBERLAINE WAY
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-2869
Practice Address - Country:US
Practice Address - Phone:760-246-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695516164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse