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General NPI Number Information
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NPI Number | 1407253446
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Entity Type | Organization
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Legal Business Name | RIVERSIDE REGIONAL SURGERY CENTER INC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 4234 RIVERWALK PKWY STE 160
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City | RIVERSIDE
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State | CA
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Zip | 92505-8510
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Country | US
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Telephone | 951-785-7772
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Fax |
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Provider Business Mailing Address
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Address Line | 4234 RIVERWALK PKWY STE 160
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City | RIVERSIDE
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State | CA
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Zip | 92505-8510
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Country | US
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Telephone | 951-785-7772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BABAR IQBAL
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Credential | M.D.
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Telephone | 951-785-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A104410
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License Number State | CA
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