Healthcare Provider Details

I. General information

NPI: 1639457872
Provider Name (Legal Business Name): RIVERSIDE COUNTY RGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

19645 TANGELO DR
RIVERSIDE CA
92508-6477
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4234
  • Fax: 951-486-5595
Mailing address:
  • Phone: 951-780-6142
  • Fax: 951-780-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number392583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number392583
License Number StateCA

VIII. Authorized Official

Name: MRS. DELIA Z REYES
Title or Position: NP
Credential: NP
Phone: 951-780-6142