Healthcare Provider Details

I. General information

NPI: 1306745328
Provider Name (Legal Business Name): UNITED STATES VETERANS INITIATIVE - RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 RIVER CREST DR STE S
RIVERSIDE CA
92507-0788
US

IV. Provider business mailing address

800 W 6TH ST STE 1505
LOS ANGELES CA
90017-2742
US

V. Phone/Fax

Practice location:
  • Phone: 951-200-4233
  • Fax:
Mailing address:
  • Phone: 213-760-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA R JACKSON ZENO
Title or Position: CVHI SPECIALIST
Credential:
Phone: 213-760-4630