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General NPI Number Information
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NPI Number | 1437374097
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Entity Type | Organization
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Legal Business Name | MOZELL E COLEMAN
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1456 W VICTORIA ST
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City | RIALTO
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State | CA
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Zip | 92376-4620
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Country | US
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Telephone | 909-717-1279
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Fax |
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Provider Business Mailing Address
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Address Line | 1456 W VICTORIA ST
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City | RIALTO
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State | CA
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Zip | 92376-4620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LVN
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Name | MOZELL COLEMAN
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Credential |
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Telephone | 909-717-1279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | EPS015780
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License Number State | CA
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