Provider Demographics
NPI:1912340118
Name:VERTUDEZ, JANICE RHEA (NP)
Entity Type:Individual
Prefix:
First Name:JANICE RHEA
Middle Name:
Last Name:VERTUDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:RHEA
Other - Last Name:ABILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2458 HILBORN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1072
Mailing Address - Country:US
Mailing Address - Phone:707-646-5500
Mailing Address - Fax:707-646-5501
Practice Address - Street 1:3108 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2325
Practice Address - Country:US
Practice Address - Phone:925-849-6634
Practice Address - Fax:925-849-6635
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily