Healthcare Provider Details

I. General information

NPI: 1467867192
Provider Name (Legal Business Name): DEBRA TERRIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 COUNTY CIRCLE DR STE 208
RIVERSIDE CA
92503-3410
US

IV. Provider business mailing address

4065 COUNTY CIRCLE DR STE 208
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-272-5453
  • Fax: 951-272-5452
Mailing address:
  • Phone: 951-272-5453
  • Fax: 951-272-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number543083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: