Organization
ST MARY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL F BISHARA M.D. (PHYSICIAN)
(951) 787-4885
Entity
Organization
Contact information
Practice address
6896 MAGNOLIA AVE, RIVERSIDE, CA 92506-2843
(951) 787-4885
(951) 787-4962
Mailing address
6896 MAGNOLIA AVE, RIVERSIDE, CA 92506-2843
(951) 787-4885
(951) 787-4962
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
00A432060
CA
Other
Enumeration date
05/04/2011
Last updated
05/04/2011
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