Healthcare Provider Details

I. General information

NPI: 1538580881
Provider Name (Legal Business Name): CORONA/RIVERSIDE HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 PIERCE ST STE J
RIVERSIDE CA
92505-3809
US

IV. Provider business mailing address

PO BOX 76002
ANAHEIM CA
92809-7602
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-1362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GEORGE YOUSSEF
Title or Position: DIRECTOR
Credential:
Phone: 714-533-4362