Provider Demographics
NPI:1821618638
Name:HANSON, RODOLFO JARAVATA (FNP-C)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:JARAVATA
Last Name:HANSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:RODOLFO JR
Other - Middle Name:CARSON
Other - Last Name:JARAVATA-HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29910 MURRIETA HOT SPRINGS RD., STE G-505
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3815
Mailing Address - Country:US
Mailing Address - Phone:562-390-6744
Mailing Address - Fax:
Practice Address - Street 1:29910 MURRIETA HOT SPRINGS RD., STE G-505
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3815
Practice Address - Country:US
Practice Address - Phone:562-390-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily