Healthcare Provider Details

I. General information

NPI: 1629498480
Provider Name (Legal Business Name): DORIANNE FERRISS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 RIVER CREST DR SUITE L
RIVERSIDE CA
92507-0788
US

IV. Provider business mailing address

30795 SONORA ST
MENIFEE CA
92584-2721
US

V. Phone/Fax

Practice location:
  • Phone: 951-413-1200
  • Fax:
Mailing address:
  • Phone: 951-609-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number621415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: