Healthcare Provider Details

I. General information

NPI: 1992699730
Provider Name (Legal Business Name): CPR CONNECT 2-7-7
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 MAGNOLIA AVE STE G
RIVERSIDE CA
92503-4900
US

IV. Provider business mailing address

11840 MAGNOLIA AVE STE G
RIVERSIDE CA
92503-4900
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-5733
  • Fax: 844-746-7646
Mailing address:
  • Phone: 951-898-5733
  • Fax: 844-746-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MARIE VERNON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 951-898-5733