Healthcare Provider Details

I. General information

NPI: 1265396691
Provider Name (Legal Business Name): MARK WOERZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 COUNTY FARM RD
RIVERSIDE CA
92503-3507
US

IV. Provider business mailing address

18612 SANTA ANA AVE
BLOOMINGTON CA
92316-2639
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-7120
  • Fax:
Mailing address:
  • Phone: 909-421-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: