Healthcare Provider Details

I. General information

NPI: 1588330534
Provider Name (Legal Business Name): COMMUNITY ACCESS NETWORK NON PROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22917 BRIARWOOD DR
CORONA CA
92883-9171
US

IV. Provider business mailing address

22917 BRIARWOOD DR
CORONA CA
92883-9171
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-3222
  • Fax: 951-279-3222
Mailing address:
  • Phone: 951-279-3222
  • Fax: 951-279-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFIK WILLIAM PHILOBOS
Title or Position: EXECUTIVE DIRECTOR
Credential: LSCW
Phone: 951-279-3222