MEDICARE: COREY LYNN SPIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1366672404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY LYNN SPIGHT

Provider Business Mailing Address
First Line	:	6235 RIVER CREST DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0788
Country	:	US
Telephone Number	:	951-653-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6235 RIVER CREST DR STE N
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0758
Country	:	US
Telephone Number	:	951-653-6571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	05/07/2024

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