Provider Demographics
NPI:1023356987
Name:RIVER OF TRADITION
Entity Type:Organization
Organization Name:RIVER OF TRADITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-753-2166
Mailing Address - Street 1:665 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE # D AND E
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3581
Mailing Address - Country:US
Mailing Address - Phone:909-626-0606
Mailing Address - Fax:323-888-2254
Practice Address - Street 1:665 E FOOTHILL BLVD
Practice Address - Street 2:SUITE # D AND E
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3581
Practice Address - Country:US
Practice Address - Phone:909-626-0606
Practice Address - Fax:323-888-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty