Healthcare Provider Details

I. General information

NPI: 1609447580
Provider Name (Legal Business Name): MRS. LORENA DHEMIMG-FOLSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 ARLINGTON AVE STE B
RIVERSIDE CA
92504-1966
US

IV. Provider business mailing address

6711 ARLINGTON AVE STE B
RIVERSIDE CA
92504-1966
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3943
  • Fax:
Mailing address:
  • Phone: 951-352-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAMFT122731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: