Basic Information
| Provider Information | |||||||||
| NPI: | 1972845535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERSIDE MEDICAL CLINIC,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3660 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516836370 | ||||||||
| FaxNumber: | 9512486708 | ||||||||
| Practice Location | |||||||||
| Address1: | 12710 LIMONITE AVE | ||||||||
| Address2: | |||||||||
| City: | EASTVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917600000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516836370 | ||||||||
| FaxNumber: | 9512486708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2013 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | CARPENTER | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT,CEO | ||||||||
| AuthorizedOfficialTelephone: | 9517823744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.