Healthcare Provider Details

I. General information

NPI: 1013705334
Provider Name (Legal Business Name): ELVIS-RAYMOND MUKWIKWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16756 CHINO CORONA RD
CORONA CA
92880-9508
US

IV. Provider business mailing address

16756 CHINO CORONA RD
CORONA CA
92880-9508
US

V. Phone/Fax

Practice location:
  • Phone: 951-310-5132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number201564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: