Healthcare Provider Details

I. General information

NPI: 1205319399
Provider Name (Legal Business Name): SHIRLEY MILUZKA SAENZ CHW SUPERVISOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE SOM EDUCATION BUILDING I OFFICE 2669
RIVERSIDE CA
92521-1520
US

IV. Provider business mailing address

900 UNIVERSITY AVE SOM EDUCATION BUILDING I OFFICE 2669
RIVERSIDE CA
92521-1520
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-3412
  • Fax:
Mailing address:
  • Phone: 951-827-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: