Provider Demographics
NPI:1871580670
Name:AWENDER, RITA (DC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:AWENDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36779 CORDOBA TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6332
Mailing Address - Country:US
Mailing Address - Phone:909-712-7910
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-330-3100
Practice Address - Fax:951-380-8596
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU59085Medicare UPIN
CADC0227870Medicare ID - Type Unspecified