Healthcare Provider Details

I. General information

NPI: 1750095758
Provider Name (Legal Business Name): LORNA VIXIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 S HARGRAVE ST
BANNING CA
92220-6169
US

IV. Provider business mailing address

12142 CENTRAL AVE # 177
CHINO CA
91710-2420
US

V. Phone/Fax

Practice location:
  • Phone: 951-922-7612
  • Fax:
Mailing address:
  • Phone: 626-779-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: