Healthcare Provider Details

I. General information

NPI: 1669925939
Provider Name (Legal Business Name): RIVERSIDE UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARLINGTON AVE
RIVERSIDE CA
92504-2035
US

IV. Provider business mailing address

3380 14TH ST
RIVERSIDE CA
92501-3810
US

V. Phone/Fax

Practice location:
  • Phone: 951-274-4213
  • Fax: 951-274-4203
Mailing address:
  • Phone: 951-274-4213
  • Fax: 951-274-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number15101
License Number StateCA

VIII. Authorized Official

Name: JOHN DAVIS
Title or Position: LEAD NURSE, HEALTH SERVICES
Credential: RN, FNP-BC
Phone: 951-274-4213