Healthcare Provider Details

I. General information

NPI: 1386485571
Provider Name (Legal Business Name): ROXANNE MCCORMICK PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 CHURCH ST
HIGHLAND CA
92346-3968
US

IV. Provider business mailing address

7701 CHURCH ST
HIGHLAND CA
92346-3968
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-5590
  • Fax: 909-307-5594
Mailing address:
  • Phone: 909-307-5590
  • Fax: 909-307-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210048181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: