Healthcare Provider Details

I. General information

NPI: 1558203729
Provider Name (Legal Business Name): MR. IAN BOND
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 ENTREFINA WAY
RIVERSIDE CA
92508-6149
US

IV. Provider business mailing address

8275 ENTREFINA WAY
RIVERSIDE CA
92508-6149
US

V. Phone/Fax

Practice location:
  • Phone: 951-999-0474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: