Healthcare Provider Details

I. General information

NPI: 1750093183
Provider Name (Legal Business Name): HURIYA TESFASILASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2155 CHICAGO AVE STE 203
RIVERSIDE CA
92507-2209
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax:
Mailing address:
  • Phone: 951-357-6926
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMPSS-OLIHUV
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-OLIHUV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: