Healthcare Provider Details

I. General information

NPI: 1982013884
Provider Name (Legal Business Name): RIVERSIDE MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19314 JESSE LN SUITE 100
RIVERSIDE CA
92508-5069
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3987
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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