Healthcare Provider Details

I. General information

NPI: 1487218236
Provider Name (Legal Business Name): MR. MAURY DEXTER LEMONS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 HARLOW AVE
RIVERSIDE CA
92503-4613
US

IV. Provider business mailing address

12751 HARLOW AVE
RIVERSIDE CA
92503-4613
US

V. Phone/Fax

Practice location:
  • Phone: 818-267-6384
  • Fax:
Mailing address:
  • Phone: 818-267-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95192159
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95192159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: