Healthcare Provider Details

I. General information

NPI: 1467286740
Provider Name (Legal Business Name): RHIANNA MAYRA NORDLUND ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18484 CALIFORNIA 18 STE 210
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

18484 CALIFORNIA 18 STE. 210
APPLE VALLEY CA
92307
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-9133
  • Fax: --
Mailing address:
  • Phone: 760-946-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number139302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: