Healthcare Provider Details

I. General information

NPI: 1255292744
Provider Name (Legal Business Name): DANIEL RAY MICRO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 MAGNOLIA AVE STE 130
RIVERSIDE CA
92504-3819
US

IV. Provider business mailing address

8008 MAGNOLIA AVE APT 20
RIVERSIDE CA
92504-3450
US

V. Phone/Fax

Practice location:
  • Phone: 951-404-0856
  • Fax:
Mailing address:
  • Phone: 951-404-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: