Healthcare Provider Details

I. General information

NPI: 1669880753
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 MISSION BLVD
RIVERSIDE CA
92509-4624
US

IV. Provider business mailing address

4065 COUNTY CIRCLE DR STE 403
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-0840
  • Fax: 951-955-5317
Mailing address:
  • Phone: 951-358-5222
  • Fax: 951-358-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRI WILSON-TORRES
Title or Position: PATIENT ACCOUNTS MANAGER
Credential:
Phone: 951-358-5998