Healthcare Provider Details

I. General information

NPI: 1053134221
Provider Name (Legal Business Name): CALIFORNIA BAPTIST UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 MAGNOLIA AVE
RIVERSIDE CA
92504-3297
US

IV. Provider business mailing address

8432 MAGNOLIA AVE
RIVERSIDE CA
92504-3297
US

V. Phone/Fax

Practice location:
  • Phone: 951-343-4702
  • Fax:
Mailing address:
  • Phone: 951-343-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PROF. AMANDA JEAN PITCHFORD
Title or Position: CLINIC ADMINISTRATOR MOBILE HEALTH
Credential: PHD(C), MSN RN, PHN-
Phone: 951-552-8155