Healthcare Provider Details

I. General information

NPI: 1033847280
Provider Name (Legal Business Name): ANTHONY RAY PIERSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

IV. Provider business mailing address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

V. Phone/Fax

Practice location:
  • Phone: 333-910-5058
  • Fax:
Mailing address:
  • Phone: 936-371-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95252686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: