Healthcare Provider Details

I. General information

NPI: 1548184104
Provider Name (Legal Business Name): RIVER DEANN PULLINS SUDRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69730 HIGHWAY 111 STE 109
RANCHO MIRAGE CA
92270-2873
US

IV. Provider business mailing address

675 N LOS FELICES CIR W
PALM SPRINGS CA
92262-0620
US

V. Phone/Fax

Practice location:
  • Phone: 760-699-8441
  • Fax:
Mailing address:
  • Phone: 760-699-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: