Provider Demographics
NPI:1245958222
Name:IRBY, RIVER ORION (RN)
Entity type:Individual
Prefix:
First Name:RIVER
Middle Name:ORION
Last Name:IRBY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:RIVER
Other - Middle Name:ORION
Other - Last Name:FERRELL-DAMRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5719 LAURETTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1635
Mailing Address - Country:US
Mailing Address - Phone:619-446-8158
Mailing Address - Fax:
Practice Address - Street 1:5454 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3621
Practice Address - Country:US
Practice Address - Phone:619-515-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95301623163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse