Healthcare Provider Details

I. General information

NPI: 1891387429
Provider Name (Legal Business Name): JEWEL GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date: 07/01/2021
Reactivation Date: 10/30/2025

III. Provider practice location address

2085 RUSTIN AVE STE 1
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2085 RUSTIN AVE STE 1
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-7320
  • Fax:
Mailing address:
  • Phone: 951-955-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: