Healthcare Provider Details

I. General information

NPI: 1184174245
Provider Name (Legal Business Name): SOLID GROUND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 BROCKTON AVE STE 9
RIVERSIDE CA
92506-3816
US

IV. Provider business mailing address

6860 BROCKTON AVE STE 9
RIVERSIDE CA
92506-3816
US

V. Phone/Fax

Practice location:
  • Phone: 951-224-9940
  • Fax:
Mailing address:
  • Phone: 951-312-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: LISA MARIE MOLINA
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 951-224-9940