Healthcare Provider Details

I. General information

NPI: 1811590318
Provider Name (Legal Business Name): FAMILY INTERVENTION NURTURING EMPOWERMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 LATHAM ST STE F
RIVERSIDE CA
92501-1737
US

IV. Provider business mailing address

4280 LATHAM ST STE F
RIVERSIDE CA
92501-1737
US

V. Phone/Fax

Practice location:
  • Phone: 858-260-0426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ELVIA CORTES
Title or Position: CEO
Credential: PHD
Phone: 858-260-0426