Provider Demographics
NPI:1871064220
Name:ALATRISTE, RICARDO IVAN (BSN RN)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:IVAN
Last Name:ALATRISTE
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15701 SHERMAN WAY UNIT 7554
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91409-8638
Mailing Address - Country:US
Mailing Address - Phone:818-309-3939
Mailing Address - Fax:
Practice Address - Street 1:2450 S SHENANDOAH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2026
Practice Address - Country:US
Practice Address - Phone:747-254-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041459379163WS0200X
MERN72054163WS0200X
CA95149758163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90042082EMedicaid