Healthcare Provider Details

I. General information

NPI: 1093397739
Provider Name (Legal Business Name): MARINA ANN HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 W BLAINE ST
RIVERSIDE CA
92507-3940
US

IV. Provider business mailing address

14320 PALM DR
DESERT HOT SPRINGS CA
92240-6874
US

V. Phone/Fax

Practice location:
  • Phone: 760-625-4478
  • Fax:
Mailing address:
  • Phone: 760-770-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberHRPSS000035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: