Provider Demographics
NPI:1932079084
Name:SOUTHERN CALIFORNIA INJURY TREATMENT CENTER MGT
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA INJURY TREATMENT CENTER MGT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-261-1263
Mailing Address - Street 1:15857 POMONA RINCON RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5505
Mailing Address - Country:US
Mailing Address - Phone:844-787-3286
Mailing Address - Fax:
Practice Address - Street 1:15857 POMONA RINCON RD
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5505
Practice Address - Country:US
Practice Address - Phone:844-787-3286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Multi-Specialty