Provider Demographics
NPI:1790498905
Name:RIVERSIDE UNIVERSITY HEALTH SYSTEM
Entity Type:Organization
Organization Name:RIVERSIDE UNIVERSITY HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:999-999-9999
Mailing Address - Street 1:258 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:258 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4311
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty