Healthcare Provider Details

I. General information

NPI: 1326651688
Provider Name (Legal Business Name): NEBI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 LIMONITE AVE STE A
RIVERSIDE CA
92509-6120
US

IV. Provider business mailing address

8175 LIMONITE AVE STE A
RIVERSIDE CA
92509-6120
US

V. Phone/Fax

Practice location:
  • Phone: 310-948-6239
  • Fax: 909-803-0067
Mailing address:
  • Phone: 310-948-6239
  • Fax: 909-803-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH NEGUSSE
Title or Position: OWNER
Credential: MD
Phone: 310-948-6239