Healthcare Provider Details

I. General information

NPI: 1104077288
Provider Name (Legal Business Name): MRS. PARIS CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PARIS CONNER-ROSCOE LMFT

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 ANNAPOLIS CIRCLE
SAN BERNARDINO CA
92408
US

IV. Provider business mailing address

986 W TIBBOT ST
RIALTO CA
92377-8200
US

V. Phone/Fax

Practice location:
  • Phone: 909-254-1781
  • Fax:
Mailing address:
  • Phone: 92-731-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number361533
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: