1700359312 NPI number — RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES

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 1700359312 NPI number — RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES
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:
Provider Other Organization Name Type Code:
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:
1700359312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1612 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COACHELLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92236-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-398-9000
Provider Business Mailing Address Fax Number:
760-398-9790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91275 66TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECCA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-398-9000
Provider Business Practice Location Address Fax Number:
760-398-9790
Provider Enumeration Date:
01/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TAPIA
Authorized Official First Name:
MARIBEL
Authorized Official Middle Name:
AYON
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
760-398-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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