Provider Demographics
NPI:1639457872
Name:RIVERSIDE COUNTY RGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:RIVERSIDE COUNTY RGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:951-780-6142
Mailing Address - Street 1:19645 TANGELO DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6477
Mailing Address - Country:US
Mailing Address - Phone:951-780-6142
Mailing Address - Fax:951-780-6142
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4234
Practice Address - Fax:951-486-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392583275N00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit