Provider Demographics
NPI:1457915167
Name:VEVODA-AGUERO, JANICE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:VEVODA-AGUERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:VEVODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:31233 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-239-2396
Mailing Address - Fax:
Practice Address - Street 1:31233 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-239-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406782163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator