Healthcare Provider Details

I. General information

NPI: 1922098037
Provider Name (Legal Business Name): JAMES A DESILVA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 MAGNOLIA AVE
RIVERSIDE CA
92504-3849
US

IV. Provider business mailing address

7310 MAGNOLIA AVE
RIVERSIDE CA
92504-3849
US

V. Phone/Fax

Practice location:
  • Phone: 951-354-8787
  • Fax: 951-354-0350
Mailing address:
  • Phone: 951-354-8787
  • Fax: 951-354-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number24000527
License Number StateCA

VIII. Authorized Official

Name: JAMES A DESILVA
Title or Position: OWNER
Credential: DPM
Phone: 951-354-8787