Healthcare Provider Details

I. General information

NPI: 1629987961
Provider Name (Legal Business Name): MISSION HEALTH MANAGEMENT ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 MISSION INN AVE STE B
RIVERSIDE CA
92507-4138
US

IV. Provider business mailing address

3133 MISSION INN AVE STE B
RIVERSIDE CA
92507-4138
US

V. Phone/Fax

Practice location:
  • Phone: 909-297-6620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE WYNDER
Title or Position: MANAGING MEMBER
Credential:
Phone: 909-297-6620