Healthcare Provider Details

I. General information

NPI: 1275087652
Provider Name (Legal Business Name): JOYCE ISRAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

7038 GOLDEN RAIN WAY
RANCHO CUCAMONGA CA
91739-1606
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-2440
  • Fax:
Mailing address:
  • Phone: 213-422-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number655842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: