Healthcare Provider Details

I. General information

NPI: 1013853431
Provider Name (Legal Business Name): MARCEL J BUGGS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD STE 2
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

17034 CAMBRIA AVE
FONTANA CA
92336-3244
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-8303
  • Fax:
Mailing address:
  • Phone: 909-275-8146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number757273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: