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General NPI Number Information
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NPI Number | 1962992206
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Entity Type | Individual
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Provider Name | PAIGE MARION TE VELDE
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Gender | Female
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 40555 CALIF OAKS RD STE 106
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City | MURRIETA
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State | CA
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Zip | 92562-5723
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Country | US
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Telephone | 951-433-0954
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Fax |
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Provider Business Mailing Address
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Address Line | 13135 LONE STALLION LN
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City | CORONA
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State | CA
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Zip | 92883-5280
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Country | US
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Telephone | 951-433-0954
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 9452
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License Number State | CA
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