Healthcare Provider Details

I. General information

NPI: 1316080880
Provider Name (Legal Business Name): RIVERSIDE MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 BROCKTON AVE
RIVERSIDE CA
92506-2614
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 Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family 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