1841338944 NPI number — BELTONE OF RIVERSIDE

Table of content: (NPI 1841338944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841338944 NPI number — BELTONE OF RIVERSIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELTONE OF RIVERSIDE
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:
6
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:
1841338944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5908 MAGNOLIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92506-1884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-779-1237
Provider Business Mailing Address Fax Number:
951-779-1238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5908 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92506-1884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-779-1237
Provider Business Practice Location Address Fax Number:
951-779-1238
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECERRIL
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
951-779-1237

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA3537 , 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)

  • Identifier: BEL-45460 . This is a "SECUREHORIZONS PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 611A63223 . This is a "BLUE CROSS OF CALIF." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ64762Z . This is a "BLUESHIELD OF CALIF." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ64762Z . This is a "UNITEDHEALTH CARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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