Healthcare Provider Details

I. General information

NPI: 1033645239
Provider Name (Legal Business Name): RIVERSIDE UNIVERSITY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SPRUCE ST SUITE A
RIVERSIDE CA
92507
US

IV. Provider business mailing address

1405 SPRUCE S SUITE A
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 951-715-5050
  • Fax:
Mailing address:
  • Phone: 951-715-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT LOZANO JR.
Title or Position: BEHAVIOR HEALTH SPECIALIST II
Credential:
Phone: 951-715-5050