Healthcare Provider Details

I. General information

NPI: 1790498905
Provider Name (Legal Business Name): RIVERSIDE UNIVERSITY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N THOMPSON ST
HEMET CA
92543-4311
US

IV. Provider business mailing address

258 N THOMPSON ST
HEMET CA
92543-4311
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROSALBA HERNANDEZ SOTO
Title or Position: REGISTERED ALCOHOL & DRUG COUNSELOR
Credential:
Phone: 999-999-9999