Healthcare Provider Details

I. General information

NPI: 1013076850
Provider Name (Legal Business Name): ARTHRITIS CENTER OF RIVERSIDE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 SLATE AVE SUITE 100
RIVERSIDE CA
92505-7100
US

IV. Provider business mailing address

11725 SLATE AVE SUITE 100
RIVERSIDE CA
92505-7100
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-1700
  • Fax: 951-352-9110
Mailing address:
  • Phone: 951-352-1700
  • Fax: 951-352-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA35128
License Number StateCA

VIII. Authorized Official

Name: MS. JESSICA HENDERSON
Title or Position: BILLING MANAGER
Credential:
Phone: 951-352-1700