Provider Demographics
NPI:1841338944
Name:BELTONE OF RIVERSIDE
Entity type:Organization
Organization Name:BELTONE OF RIVERSIDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BECERRIL
Authorized Official - Suffix:
Authorized Official - Credentials:ACA
Authorized Official - Phone:951-779-1237
Mailing Address - Street 1:5908 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1884
Mailing Address - Country:US
Mailing Address - Phone:951-779-1237
Mailing Address - Fax:951-779-1238
Practice Address - Street 1:5908 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1884
Practice Address - Country:US
Practice Address - Phone:951-779-1237
Practice Address - Fax:951-779-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3537237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABEL-45460OtherSECUREHORIZONS PACIFICARE
CA611A63223OtherBLUE CROSS OF CALIF.
CAZZZ64762ZOtherBLUESHIELD OF CALIF.
CAZZZ64762ZOtherUNITEDHEALTH CARE
CAZZZ64762ZOtherUNITEDHEALTH CARE