Provider Demographics
NPI:1013076850
Name:ARTHRITIS CENTER OF RIVERSIDE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ARTHRITIS CENTER OF RIVERSIDE MEDICAL CORPORATION
Other - Org Name:ARTHRITIS CENTER OF RIVERSIDE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-352-1700
Mailing Address - Street 1:11725 SLATE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7100
Mailing Address - Country:US
Mailing Address - Phone:951-352-1700
Mailing Address - Fax:951-352-9110
Practice Address - Street 1:11725 SLATE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7100
Practice Address - Country:US
Practice Address - Phone:951-352-1700
Practice Address - Fax:951-352-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35128207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0575313OtherCLIA # ARTHRITIS CENTER
CAA27688Medicare UPIN
CA05D0575313OtherCLIA # ARTHRITIS CENTER