Healthcare Provider Details

I. General information

NPI: 1891453841
Provider Name (Legal Business Name): CJ HUTCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE BLDG II
RIVERSIDE CA
92521-1020
US

IV. Provider business mailing address

100 WOODRUFF CIR NE
ATLANTA GA
30322-1020
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-4618
  • Fax: 951-263-7238
Mailing address:
  • Phone:
  • Fax:

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: