Healthcare Provider Details

I. General information

NPI: 1043658990
Provider Name (Legal Business Name): UC RIVERSIDE GRADUATE MEDICAL EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCHOOL OF MEDICINE EDUCATION BUILDING 900 UNIVERSITY AVENUE
RIVERSIDE CA
92521-0001
US

IV. Provider business mailing address

SCHOOL OF MEDICINE EDUCATION BUILDING 900 UNIVERSITY AVENUE
RIVERSIDE CA
92521-0001
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: SHARDAI WILLIAMS
Title or Position: MEDICAL EDUCATION COORDINATOR
Credential:
Phone: 951-827-7669