Healthcare Provider Details

I. General information

NPI: 1770659278
Provider Name (Legal Business Name): HARVEY A NURICK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 INDIANA AVE # 100
RIVERSIDE CA
92504-4543
US

IV. Provider business mailing address

7111 INDIANA AVE # 100
RIVERSIDE CA
92504-4543
US

V. Phone/Fax

Practice location:
  • Phone: 951-276-9012
  • Fax: 951-276-9163
Mailing address:
  • Phone: 951-276-9012
  • Fax: 951-276-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC414540
License Number StateCA

VIII. Authorized Official

Name: HARVEY NURICK
Title or Position: OWNER
Credential: M.D.
Phone: 951-276-9012