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Individual

MAVY ANGELA CARRASCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 955-3448
Mailing address
21518 OLD ELSINORE RD, PERRIS, CA 92570-9527
(951) 437-3496

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CA

Other

Enumeration date
09/30/2022
Last updated
09/30/2022
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