Basic Information
| Provider Information | |||||||||
| NPI: | 1982013884 | ||||||||
| 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: | 19314 JESSE LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925085069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516836370 | ||||||||
| FaxNumber: | 9512486708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2014 | ||||||||
| LastUpdateDate: | 08/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | JUDY | ||||||||
| AuthorizedOfficialFirstName: | CARPENTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, COO | ||||||||
| AuthorizedOfficialTelephone: | 9517823744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | COO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.