Healthcare Provider Details

I. General information

NPI: 1649933557
Provider Name (Legal Business Name): NEAL COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 E BROCKTON AVE
REDLANDS CA
92374-3611
US

IV. Provider business mailing address

6700 INDIANA AVE
RIVERSIDE CA
92506-4290
US

V. Phone/Fax

Practice location:
  • Phone: 909-328-1830
  • Fax: 909-328-1827
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: