Healthcare Provider Details

I. General information

NPI: 1235431172
Provider Name (Legal Business Name): INSCRIPTIONS CHILDREN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36243 INLAND VALLEY DR SUITE #80
WILDOMAR CA
92595-9549
US

IV. Provider business mailing address

36243 INLAND VALLEY DR SUITE #80
WILDOMAR CA
92595-9549
US

V. Phone/Fax

Practice location:
  • Phone: 951-813-3760
  • Fax: 951-813-3761
Mailing address:
  • Phone: 951-813-3760
  • Fax: 951-813-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A9032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1669
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16134
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIAM W FAHIM
Title or Position: PEDIATRICS
Credential: D.O
Phone: 951-813-3760