Healthcare Provider Details

I. General information

NPI: 1073663605
Provider Name (Legal Business Name): NEIGHBORHOOD MEDICAL CLINIC OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 ARLINGTON AVE SUITE B
RIVERSIDE CA
92504-2738
US

IV. Provider business mailing address

231 E ALESSANDRO BLVD A805
RIVERSIDE CA
92508-5084
US

V. Phone/Fax

Practice location:
  • Phone: 951-341-8930
  • Fax: 951-341-8932
Mailing address:
  • Phone: 951-341-8935
  • Fax: 951-341-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA JENKINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-341-8935