Healthcare Provider Details

I. General information

NPI: 1720183403
Provider Name (Legal Business Name): RIVERSIDE MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 BROCKTON AVE FL 2
RIVERSIDE CA
92506-2620
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3987
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6370
  • Fax:
Mailing address:
  • Phone: 951-683-6370
  • Fax: 951-248-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ANUPAM GUPTA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 951-683-6370