Healthcare Provider Details

I. General information

NPI: 1114167046
Provider Name (Legal Business Name): GARY PIASCIK MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GARY PIASCIK MFTI

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 ARLINGTON AVE
RIVERSIDE CA
92504-1955
US

IV. Provider business mailing address

PO BOX 79302
CORONA CA
92877-0176
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-4964
  • Fax:
Mailing address:
  • Phone: 951-768-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC60543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: