Healthcare Provider Details

I. General information

NPI: 1578840203
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 MAGNOLIA AVE
RIVERSIDE CA
92503-4431
US

IV. Provider business mailing address

9010 MAGNOLIA AVE
RIVERSIDE CA
92503-4431
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-8914
  • Fax: 928-669-3232
Mailing address:
  • Phone: 951-509-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DEE HUTCHISON
Title or Position: CEO
Credential:
Phone: 928-669-2137