Healthcare Provider Details

I. General information

NPI: 1831812072
Provider Name (Legal Business Name): RIVERSIDE PRIMARY CARE DOCTORS-INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9041 MAGNOLIA AVE STE 6
RIVERSIDE CA
92503-3941
US

IV. Provider business mailing address

9041 MAGNOLIA AVE STE 6
RIVERSIDE CA
92503-3941
US

V. Phone/Fax

Practice location:
  • Phone: 951-224-6000
  • Fax: 951-228-0206
Mailing address:
  • Phone: 951-224-6000
  • Fax: 951-228-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FADY FAYAD
Title or Position: CEO/OWNER
Credential: MD
Phone: 951-224-6000