Healthcare Provider Details

I. General information

NPI: 1841010063
Provider Name (Legal Business Name): CAMILLE RICE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6848 MAGNOLIA AVE STE 200
RIVERSIDE CA
92506-2898
US

IV. Provider business mailing address

25590 PROSPECT AVE APT 47G
LOMA LINDA CA
92354-3156
US

V. Phone/Fax

Practice location:
  • Phone: 951-779-1966
  • Fax:
Mailing address:
  • Phone: 530-391-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: