Healthcare Provider Details

I. General information

NPI: 1669943155
Provider Name (Legal Business Name): MARIELENA CID RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DRIVE PROBST BLDG. 100B
RANCHO MIRAGE CA
92270
US

IV. Provider business mailing address

39000 BOB HOPE DRIVE PROBST 100-B
RANCHO MIRAGE CA
92270-3227
US

V. Phone/Fax

Practice location:
  • Phone: 760-837-8718
  • Fax: 760-773-1880
Mailing address:
  • Phone: 760-837-8718
  • Fax: 760-773-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: