RIVERSIDE PSYCHIATRIC MEDICAL GROUP NPI 1972691228

NPI Information

RIVERSIDE PSYCHIATRIC MEDICAL GROUP is a mental health (including community mental health center) clinic center in Riverside, CA. RIVERSIDE PSYCHIATRIC MEDICAL GROUP NPI is 1972691228. The provider is registered as an organization entity type.
The provider Other Name Is Riverside Psych Med Group.

The provider's business location address is:

5887 BROCKTON AVE
STE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
RIVERSIDE, CA
ZIP 92506
Phone: (951) 275-8500
Fax: (951) 275-8560

The provider's authorized official is Robert B. Summerour .
The authorized official title is Owner and has the following contact phone number (951) 275-8500.

The CLIA number assigned to this NPI record is 05D2162307 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/11/2006 and was last updated on 12/20/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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