Juan Cornell

NPI 1790265650 · on the registry since 2018 · sole proprietor

Practice

Address: 1622 Palermo Dr
Riverside, CA 92507
Phone: (562) 685-4610
Fax: (951) 213-6898
Organisation at this address: The Emmanuel Project
Eagel Time Care Facility
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 2

Registry record

Primary taxonomy: 310400000X
310400000X
Licence states on file: CA
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2018-08-20

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California