Provider Demographics
NPI:1972292498
Name:AMBRIZ, PATRICIA P (LVN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:AMBRIZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 STREETER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1682
Mailing Address - Country:US
Mailing Address - Phone:626-931-9149
Mailing Address - Fax:
Practice Address - Street 1:2452 WILSHIRE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2144
Practice Address - Country:US
Practice Address - Phone:951-682-6631
Practice Address - Fax:951-682-6614
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141185164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse