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General NPI Number Information
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NPI Number | 1306735360
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Entity Type | Individual
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Provider Name | MARK LAWRENCE MEAD RN
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Gender | Male
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 3950 REYNOLDS RD
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City | RIVERSIDE
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State | CA
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Zip | 92503-3517
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Country | US
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Telephone | 951-358-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 35316 THORPE TRL
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City | BEAUMONT
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State | CA
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Zip | 92223-6240
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Country | US
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Telephone | 909-557-8270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95124546
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License Number State | CA
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