1871881763 NPI number — RIVERSIDE COMMUNITY HEALTH PLAN MEDICAL GROUP, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871881763 NPI number — RIVERSIDE COMMUNITY HEALTH PLAN MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE COMMUNITY HEALTH PLAN MEDICAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIVERSIDE PHYSICIAN NETWORK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871881763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 IOWA AVE
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92507-2472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-788-9800
Provider Business Mailing Address Fax Number:
951-788-0098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 IOWA AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92507-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-788-9800
Provider Business Practice Location Address Fax Number:
951-788-0098
Provider Enumeration Date:
07/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SANER
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
951-788-9800

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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