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General NPI Number Information
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NPI Number | 1316080880
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Entity Type | Organization
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Legal Business Name | RIVERSIDE MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 7150 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2614
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Country | US
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Telephone | 951-683-6370
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Fax |
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Provider Business Mailing Address
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Address Line | 3660 ARLINGTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-3987
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Country | US
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Telephone | 951-683-6370
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Fax | 951-248-6708
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANUPAM GUPTA
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Credential | MD
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Telephone | 951-683-6370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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