Healthcare Provider Details

I. General information

NPI: 1073960043
Provider Name (Legal Business Name): MARCIA JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MAGNOLIA AVE
RIVERSIDE CA
92506-1201
US

IV. Provider business mailing address

2129 WEMBLEY LN
CORONA CA
92881-7442
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-8151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number535386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: