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General NPI Number Information
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NPI Number | 1902405715
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 3978 MERRILL AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506
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Country | US
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Telephone | 951-698-1118
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Fax |
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Provider Business Mailing Address
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Address Line | 29995 TECHNOLOGY DR # A202
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City | MURRIETA
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State | CA
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Zip | 92563-2632
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Country | US
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Telephone | 951-968-1309
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | ALDO DIAZ
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Credential |
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Telephone | 951-402-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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