Healthcare Provider Details

I. General information

NPI: 1407997018
Provider Name (Legal Business Name): SHEILA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060A COUNTY CIRCLE DRIVE
RIVERSIDE CA
92503-5000
US

IV. Provider business mailing address

1437 W F ST
ONTARIO CA
91762-2412
US

V. Phone/Fax

Practice location:
  • Phone: 351-358-6919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: