Provider Demographics
NPI:1043658990
Name:UC RIVERSIDE GRADUATE MEDICAL EDUCATION
Entity Type:Organization
Organization Name:UC RIVERSIDE GRADUATE MEDICAL EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL EDUCATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARDAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-827-7669
Mailing Address - Street 1:SCHOOL OF MEDICINE EDUCATION BUILDING
Mailing Address - Street 2:900 UNIVERSITY AVENUE
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92521-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL OF MEDICINE EDUCATION BUILDING
Practice Address - Street 2:900 UNIVERSITY AVENUE
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92521-0001
Practice Address - Country:US
Practice Address - Phone:951-827-7669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QC0050X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital