Healthcare Provider Details

I. General information

NPI: 1316635022
Provider Name (Legal Business Name): BONNIE ELAINE RILEY OCONNELL CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N STATE ST STE E
HEMET CA
92543-1485
US

IV. Provider business mailing address

25967 YALE ST
HEMET CA
92544-4877
US

V. Phone/Fax

Practice location:
  • Phone: 951-654-2026
  • Fax:
Mailing address:
  • Phone: 951-581-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-JYHGUQ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: