Healthcare Provider Details

I. General information

NPI: 1255291845
Provider Name (Legal Business Name): MEGAN MIDORI MIYAMURA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7888 MISSION GROVE PKWY S STE 200
RIVERSIDE CA
92508-5064
US

IV. Provider business mailing address

7888 MISSION GROVE PKWY S STE 200
RIVERSIDE CA
92508-5064
US

V. Phone/Fax

Practice location:
  • Phone: 909-386-6000
  • Fax:
Mailing address:
  • Phone: 909-261-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95427100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: