Individual provider · NPI-1

James Paul Black

Community Health Worker · Loma Linda, CA

NPI number1073358792
StatusActive
Last updated in NPPESJun 25, 2024

Details

NPI
1073358792
Entity type
Individual (NPI-1)
Name
James Paul Black
Sex
Male
Sole proprietor
No
Enumeration date
Jun 25, 2024
Certification date
Jun 25, 2024
Last updated
Jun 25, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172V00000X Community Health Worker––Yes

Practice location

11374 Mountain View Ave Ste A
Loma Linda, CA 92354-3816

Phone 909-558-6715

Mailing address

33979 Lily Rd # 92
Yucaipa, CA 92399-2287

Phone 714-872-3970

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