Healthcare Provider Details

I. General information

NPI: 1578256301
Provider Name (Legal Business Name): ARIANA APARICIO PHILLIPS, O.D., CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 INDIANA AVE STE 155
RIVERSIDE CA
92506-4225
US

IV. Provider business mailing address

6700 INDIANA AVE STE 155
RIVERSIDE CA
92506-4225
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-1600
  • Fax:
Mailing address:
  • Phone: 951-682-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: ARIANA APARICIO PHILLIPS
Title or Position: PRESIDENT
Credential: OD
Phone: 951-823-3720