Provider Demographics
NPI:1417910886
Name:RIVERWALK PEDIATRIC CLINIC INC
Entity Type:Organization
Organization Name:RIVERWALK PEDIATRIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HASMUKH
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-663-7500
Mailing Address - Street 1:9508 STOCKDALE HWY
Mailing Address - Street 2:STE 150
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-663-7500
Mailing Address - Fax:661-663-3063
Practice Address - Street 1:9508 STOCKDALE HWY
Practice Address - Street 2:STE 150
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-663-7500
Practice Address - Fax:661-663-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101310Medicaid