Provider Demographics
NPI:1790713394
Name:RIVERSIDE FAMILY PHYSICIANS, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RIVERSIDE FAMILY PHYSICIANS, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:ZAKI
Authorized Official - Last Name:MAHDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-781-6335
Mailing Address - Street 1:4310 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3829
Mailing Address - Country:US
Mailing Address - Phone:951-781-6335
Mailing Address - Fax:951-781-6365
Practice Address - Street 1:4310 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3829
Practice Address - Country:US
Practice Address - Phone:951-781-6335
Practice Address - Fax:951-781-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26612ZMedicare PIN
CAZZZ26611ZMedicare PIN