Healthcare Provider Details

I. General information

NPI: 1841197084
Provider Name (Legal Business Name): RIVERSIDE MEDICAL CLINIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2026
Last Update Date: 10/21/2026
Certification Date: 10/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E RIVERSIDE DR
MADERA CA
93638-2439
US

IV. Provider business mailing address

405 E RIVERSIDE DR
MADERA CA
93638-2439
US

V. Phone/Fax

Practice location:
  • Phone: 559-355-1835
  • Fax: 559-661-0744
Mailing address:
  • Phone: 559-355-1835
  • Fax: 559-661-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOSEPHINE C HERNANDEZ
Title or Position: OFFICE MANAGER559
Credential:
Phone: 559-355-1835