MEDICARE: RIVERSIDE UNIFIED SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center	15101	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669925939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE UNIFIED SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	3380 14TH ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-3810
Country	:	US
Telephone Number	:	951-274-4213
Fax Number	:	951-274-4203

Provider Business Practice Location Address
First Line	:	5700 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2035
Country	:	US
Telephone Number	:	951-274-4213
Fax Number	:	951-274-4203

Authorized Official
Title or Position	:	LEAD NURSE, HEALTH SERVICES
Name	:	JOHN DAVIS
Credential	:	RN, FNP-BC
Telephone Number	:	951-274-4213

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

Similar Medicare Providers

1134345952 — RIVERSIDE UNIFIED SCHOOL DISTRICT
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Directions to “RIVERSIDE UNIFIED SCHOOL DISTRICT ” Practice Location

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