Healthcare Provider Details

I. General information

NPI: 1386152759
Provider Name (Legal Business Name): ANNIE MARIE HAKOPIAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

IV. Provider business mailing address

650 N STATE ST
HEMET CA
92543-2960
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax: 951-686-4357
Mailing address:
  • Phone: 951-791-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number621366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: