Healthcare Provider Details

I. General information

NPI: 1902079569
Provider Name (Legal Business Name): RUBEN DARIO TOSCANINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4278 QUENTON DR
RIVERSIDE CA
92505-1555
US

IV. Provider business mailing address

4278 QUENTON DR
RIVERSIDE CA
92505-1555
US

V. Phone/Fax

Practice location:
  • Phone: 951-850-9882
  • Fax:
Mailing address:
  • Phone: 951-850-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number022969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: