Healthcare Provider Details

I. General information

NPI: 1194712315
Provider Name (Legal Business Name): RAINCROSS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE
RIVERSIDE CA
92506-0102
US

IV. Provider business mailing address

4646 BROCKTON AVE
RIVERSIDE CA
92506-0102
US

V. Phone/Fax

Practice location:
  • Phone: 951-774-2881
  • Fax: 951-774-2846
Mailing address:
  • Phone: 951-774-2881
  • Fax: 951-774-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH ANN NOVELLINO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 951-774-2881