Provider Demographics
NPI:1376661090
Name:SOUTHERN CALIFORNIA OCCUPATIONAL MEDICINE PROVIDERS, AMC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA OCCUPATIONAL MEDICINE PROVIDERS, AMC
Other - Org Name:RIVERSIDE INDUSTRIAL MED CLINIC & URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SABNANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-682-2222
Mailing Address - Street 1:1405 SPRUCE ST.
Mailing Address - Street 2:STE. F,
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507
Mailing Address - Country:US
Mailing Address - Phone:951-682-2222
Mailing Address - Fax:951-682-2247
Practice Address - Street 1:1405 SPRUCE ST.
Practice Address - Street 2:STE. F,
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-682-2222
Practice Address - Fax:951-682-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5845207Q00000X, 207R00000X, 2083X0100X, 261QP2000X, 261QP2300X, 261QU0200X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty