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General NPI Number Information
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NPI Number | 1902450810
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CALIFORNIA, HEALTH RIVERSIDE
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 79430 HIGHWAY 111 STE 102
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City | LA QUINTA
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State | CA
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Zip | 92253-4549
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Country | US
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Telephone | 844-827-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 14350 MERIDIAN PKWY
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City | RIVERSIDE
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State | CA
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Zip | 92518-3035
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Country | US
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Telephone | 760-561-7336
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Fax |
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Authorized Official
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Title or Position | QUALITY OUTCOMES MANAGER
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Name | NASTASSIA VALENZUELA
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Credential |
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Telephone | 760-808-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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