Healthcare Provider Details

I. General information

NPI: 1437343654
Provider Name (Legal Business Name): IRENE MARINAS-OLIVER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 BRIANWOOD DR
RIVERSIDE CA
92503-6752
US

IV. Provider business mailing address

12222 BRIANWOOD DR
RIVERSIDE CA
92503-6752
US

V. Phone/Fax

Practice location:
  • Phone: 951-333-3515
  • Fax: 951-688-6857
Mailing address:
  • Phone: 951-333-3515
  • Fax: 866-534-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number806369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: