Healthcare Provider Details

I. General information

NPI: 1871881763
Provider Name (Legal Business Name): RIVERSIDE COMMUNITY HEALTH PLAN MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 IOWA AVE SUITE 220
RIVERSIDE CA
92507-2472
US

IV. Provider business mailing address

1650 IOWA AVE SUITE 220
RIVERSIDE CA
92507-2472
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-9800
  • Fax: 951-788-0098
Mailing address:
  • Phone: 951-788-9800
  • Fax: 951-788-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. HOWARD SANER
Title or Position: CEO
Credential:
Phone: 951-788-9800