Healthcare Provider Details

I. General information

NPI: 1184782583
Provider Name (Legal Business Name): NEIGHBORHOOD MEDICAL CLINIC OF RIVERSIDE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 ARLINGTON AVE SUITE B
RIVERSIDE CA
92504-2738
US

IV. Provider business mailing address

PO BOX 5109
RIVERSIDE CA
92517-5109
US

V. Phone/Fax

Practice location:
  • Phone: 951-341-8930
  • Fax: 951-341-8932
Mailing address:
  • Phone: 951-341-8935
  • Fax: 951-341-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG549970
License Number StateCA

VIII. Authorized Official

Name: DR. SAMUEL DEY
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 951-341-8935