Healthcare Provider Details

I. General information

NPI: 1073691101
Provider Name (Legal Business Name): DUSTIN DREW TEXEIRA REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 W BLAINE ST SUITE A
RIVERSIDE CA
92507-3970
US

IV. Provider business mailing address

19218 HILLWARD CT
RIVERSIDE CA
92508-6213
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6895
  • Fax: 951-358-6176
Mailing address:
  • Phone: 951-358-6895
  • Fax: 951-358-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN 362365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: