Provider Demographics
NPI:1669925939
Name:RIVERSIDE UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:RIVERSIDE UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD NURSE, HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FNP-BC
Authorized Official - Phone:951-274-4213
Mailing Address - Street 1:3380 14TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3810
Mailing Address - Country:US
Mailing Address - Phone:951-274-4213
Mailing Address - Fax:951-274-4203
Practice Address - Street 1:5700 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2035
Practice Address - Country:US
Practice Address - Phone:951-274-4213
Practice Address - Fax:951-274-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15101261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760426449Medicaid
CA1710189352Medicaid