Healthcare Provider Details

I. General information

NPI: 1194189001
Provider Name (Legal Business Name): NEVILLE KEITH ALLEN PEER SUPPORT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD SUITE 6
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

9825 MAGNOLIA AVE SUITE B, PMB 322
RIVERSIDE CA
92503-3562
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2499
  • Fax:
Mailing address:
  • Phone: 951-509-2499
  • 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:
Title or Position:
Credential:
Phone: