Healthcare Provider Details

I. General information

NPI: 1023848637
Provider Name (Legal Business Name): PAYNE FAMILY NURSING AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 CORPORATE TERRACE CIR
CORONA CA
92879-6028
US

IV. Provider business mailing address

19069 VAN BUREN BLVD STE 114 PMB 491
RIVERSIDE CA
92508-2548
US

V. Phone/Fax

Practice location:
  • Phone: 951-543-7712
  • Fax:
Mailing address:
  • Phone: 951-543-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAM PAYNE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: NP
Phone: 951-543-7712