Provider Demographics
NPI:1902450810
Name:UNIVERSITY OF CALIFORNIA, HEALTH RIVERSIDE
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, HEALTH RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY OUTCOMES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NASTASSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-808-0664
Mailing Address - Street 1:14350 MERIDIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-3035
Mailing Address - Country:US
Mailing Address - Phone:760-561-7336
Mailing Address - Fax:
Practice Address - Street 1:79430 HIGHWAY 111 STE 102
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4549
Practice Address - Country:US
Practice Address - Phone:844-827-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty