Provider Demographics
NPI:1336359090
Name:RETUYAN, EDWIN SOLIVEN (RNFA)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:SOLIVEN
Last Name:RETUYAN
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 HITCHING POST CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8840
Mailing Address - Country:US
Mailing Address - Phone:909-803-0081
Mailing Address - Fax:
Practice Address - Street 1:27300 IRIS AVENUE
Practice Address - Street 2:
Practice Address - City:MORENEO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-243-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625403163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant