Provider Demographics
NPI:1710172242
Name:RIVERSIDE HEALTH CLINIC OF COLUSA
Entity Type:Organization
Organization Name:RIVERSIDE HEALTH CLINIC OF COLUSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIDHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-458-2300
Mailing Address - Street 1:1215 PLUMAS ST
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3455
Mailing Address - Country:US
Mailing Address - Phone:530-674-2100
Mailing Address - Fax:530-674-2277
Practice Address - Street 1:717 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2851
Practice Address - Country:US
Practice Address - Phone:530-458-2300
Practice Address - Fax:530-458-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51440207R00000X
CAA70328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty