1699987719 NPI number — RIVERSIDE COUNTY DEPARTMENT OF MENTAL HEALTH

Table of content: D LYN DYAN LEE LMP (NPI 1447467188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699987719 NPI number — RIVERSIDE COUNTY DEPARTMENT OF MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE COUNTY DEPARTMENT OF MENTAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699987719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22338 WITCHHAZEL AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-653-2056
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3525 PRESLEY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-782-2400
Provider Business Practice Location Address Fax Number:
951-683-4904
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
DELFINA
Authorized Official Title or Position:
SBHS
Authorized Official Telephone Number:
951-782-2400

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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