Healthcare Provider Details

I. General information

NPI: 1023339025
Provider Name (Legal Business Name): MR. RICHARD LOWELL YARBROUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE # 4
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2085 RUSTIN AVE # 4
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax: 951-558-0109
Mailing address:
  • Phone: 951-955-8000
  • Fax: 951-558-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMPSS-XVG4DX
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: