Healthcare Provider Details

I. General information

NPI: 1467286740
Provider Name (Legal Business Name): RHIANNA MAYRA NORDLUND ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13333 PALMDALE RD
VICTORVILLE CA
92392-9364
US

IV. Provider business mailing address

13333 PALMDALE RD
VICTORVILLE CA
92392-9364
US

V. Phone/Fax

Practice location:
  • Phone: 760-487-3600
  • Fax: --
Mailing address:
  • Phone: 607-487-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: