Provider Demographics
NPI:1831812072
Name:RIVERSIDE PRIMARY CARE DOCTORS-INC
Entity type:Organization
Organization Name:RIVERSIDE PRIMARY CARE DOCTORS-INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-224-6000
Mailing Address - Street 1:9041 MAGNOLIA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3941
Mailing Address - Country:US
Mailing Address - Phone:951-224-6000
Mailing Address - Fax:951-228-0206
Practice Address - Street 1:9041 MAGNOLIA AVE STE 6
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3941
Practice Address - Country:US
Practice Address - Phone:951-224-6000
Practice Address - Fax:951-228-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC172881OtherCA