Healthcare Provider Details

I. General information

NPI: 1932776259
Provider Name (Legal Business Name): ROXIEANNE ANTONIQUE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2021
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23950 PRADO LN
COLTON CA
92324-9734
US

IV. Provider business mailing address

23950 PRADO LN
COLTON CA
92324-9734
US

V. Phone/Fax

Practice location:
  • Phone: 909-514-1958
  • Fax:
Mailing address:
  • Phone: 909-514-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number706587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: