Healthcare Provider Details

I. General information

NPI: 1083557706
Provider Name (Legal Business Name): AVISHA PRASHANT JAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 LEMON ST STE 500
RIVERSIDE CA
92501-3374
US

IV. Provider business mailing address

3880 LEMON ST STE 500
RIVERSIDE CA
92501-3374
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-1299
  • Fax: 951-405-8029
Mailing address:
  • Phone: 951-530-1299
  • Fax: 951-405-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: