=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962575779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF RIVERSIDE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 CORONA AVE
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-1074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-736-3396
-----------------------------------------------------
Fax | 951-736-7127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P. 0. BOX 7600
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92513-9923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-358-5401
-----------------------------------------------------
Fax | 951-358-5150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHO - ADMIN PHYSICIAN III
-----------------------------------------------------
Name | GEOFFREY WON-CHEN LEUNG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 951-358-5121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------