Provider Demographics
NPI:1699153254
Name:VITUG, EDNA
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:VITUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 TELEPHONE AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5771
Mailing Address - Country:US
Mailing Address - Phone:909-465-9002
Mailing Address - Fax:909-465-9032
Practice Address - Street 1:14125 TELEPHONE AVE STE 14
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5771
Practice Address - Country:US
Practice Address - Phone:909-465-9002
Practice Address - Fax:909-465-9032
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002541163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice