Healthcare Provider Details

I. General information

NPI: 1003764085
Provider Name (Legal Business Name): HIS DAUGHTERS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 RIVERWALK PKWY STE 100
RIVERSIDE CA
92505-3313
US

IV. Provider business mailing address

3870 LA SIERRA AVE STE 100
RIVERSIDE CA
92505-3528
US

V. Phone/Fax

Practice location:
  • Phone: 888-413-9008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TOLIA TERRELL-VERNON
Title or Position: COO
Credential:
Phone: 714-713-2121