Provider Information for 1558699678
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MICHELLE OWUSU PCCI
Sex: Female
NPI: 1558699678
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1558699678 | ||||||||||||
| Enumeration Date | 2009-12-01 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 9825 MAGNOLIA AVE STE B RIVERSIDE, CA 92503-3565 United States Phone: 951-509-2499 | Fax: | ||||||||||||
| Primary Practice Address | 9890 COUNTY FARM RD STE 2 RIVERSIDE, CA 92503-3678 United States Phone: 951-509-2499 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 440 W BOUGHTON RD | ||||||||||||
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