Healthcare Provider Details

I. General information

NPI: 1275608937
Provider Name (Legal Business Name): COMMUNITY MEDICAL GROUP OF RIVERSIDE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 MAGNOLIA AVE
RIVERSIDE CA
92501-4136
US

IV. Provider business mailing address

4444 MAGNOLIA AVE
RIVERSIDE CA
92501-4136
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-5661
  • Fax: 951-274-3411
Mailing address:
  • Phone: 951-682-5661
  • Fax: 951-274-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY SWALLEY
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 951-274-3446