Healthcare Provider Details

I. General information

NPI: 1003726811
Provider Name (Legal Business Name): PATRICE MCKINSTRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 N LILAC AVE
RIALTO CA
92376-2775
US

IV. Provider business mailing address

1610 N LILAC AVE
RIALTO CA
92376-2775
US

V. Phone/Fax

Practice location:
  • Phone: 951-732-6374
  • Fax: 951-732-6374
Mailing address:
  • Phone: 951-732-6374
  • Fax: 951-732-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: