Healthcare Provider Details

I. General information

NPI: 1871350157
Provider Name (Legal Business Name): PATRICIA S FARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8554 ROSEMARY DR
RIVERSIDE CA
92508-2965
US

IV. Provider business mailing address

8554 ROSEMARY DR
RIVERSIDE CA
92508-2965
US

V. Phone/Fax

Practice location:
  • Phone: 909-773-8523
  • Fax:
Mailing address:
  • Phone: 909-773-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95105221
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: