Provider Demographics
NPI:1184782583
Name:NEIGHBORHOOD MEDICAL CLINIC OF RIVERSIDE INC
Entity type:Organization
Organization Name:NEIGHBORHOOD MEDICAL CLINIC OF RIVERSIDE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-341-8935
Mailing Address - Street 1:PO BOX 5109
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-5109
Mailing Address - Country:US
Mailing Address - Phone:951-341-8935
Mailing Address - Fax:951-341-8932
Practice Address - Street 1:4960 ARLINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2738
Practice Address - Country:US
Practice Address - Phone:951-341-8930
Practice Address - Fax:951-341-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5499702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33GHAIOtherCOUNTY SPECIALIST ID
CA7078316OtherAETNA
CADE8880OtherPALMETTO GBA
CA33GH00OtherCOUNTY SPECIALIST ID
CAZZZ16441OtherTRIWEST
CAZZZ65471ZOtherBLUE SHIELD
CA=========OtherCIGNA
CADE8880OtherPALMETTO GBA
CAZZZ16441OtherTRIWEST
CA=========OtherCIGNA
CA=========OtherPBHI
CADE8880OtherPALMETTO GBA
CAZZZ16441OtherTRIWEST