Healthcare Provider Details

I. General information

NPI: 1790713394
Provider Name (Legal Business Name): RIVERSIDE FAMILY PHYSICIANS, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

IV. Provider business mailing address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-6335
  • Fax: 951-781-6365
Mailing address:
  • Phone: 951-781-6335
  • Fax: 951-781-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TAREK ZAKI MAHDI
Title or Position: PRESIDENT/PHYSICICIAN
Credential: M.D.
Phone: 951-781-6335