Healthcare Provider Details

I. General information

NPI: 1164722682
Provider Name (Legal Business Name): RIVERSIDE INCARE HOSPITALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

4435 BROCKTON AVE STE B
RIVERSIDE CA
92501-4004
US

V. Phone/Fax

Practice location:
  • Phone: 866-202-3428
  • Fax: 951-750-1091
Mailing address:
  • Phone: 951-683-6830
  • Fax: 951-282-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK NGUYEN
Title or Position: MD
Credential:
Phone: 951-683-6830