Individual provider Active NPI

Edwin Soliven Retuyan, RNFA

  • Registered Nurse First Assistant
  • Moreneo Valley, CA
National Provider Identifier
1336359090
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered Nurse First AssistantTaxonomy code 163WR0006X
License
625403 Issued in CA
Practice address
27300 Iris Avenue
Moreneo Valley, CA 92555
Phone
(951) 243-2042
NPI assigned
May 23, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse First Assistant 163WR0006X 625403 CA Primary

Addresses

Primary practice location

27300 Iris Avenue
Moreneo Valley, CA 92555

Mailing address

7661 Hitching Post CT
Rancho Cucamonga, CA 91739-8840
Phone (909) 803-0081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
625403CAMDRegistered Nurse First Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336359090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7661 HITCHING POST CT",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917398840",
            "telephone_number": "909-803-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27300 IRIS AVENUE",
            "city": "MORENEO VALLEY",
            "state": "CA",
            "postal_code": "92555",
            "telephone_number": "951-243-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETUYAN",
        "first_name": "EDWIN",
        "middle_name": "SOLIVEN",
        "name_prefix": "Mr.",
        "credential": "RNFA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "CA",
            "license": "625403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.