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Organization
RIVERSIDE REGIONAL PEDIATRIC MEDICAL GROUP, INC.
Active
Organization
RIVERSIDE REGIONAL PEDIATRIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUILLERMO VALENZUELA M.D (PRESIDENT/OWNER)
(909) 580-6320
Entity
Organization
Contact information
Practice address
180 E 4TH ST # C, PERRIS, CA 92570-2125
(951) 943-8899
(951) 943-4598
Mailing address
180 E 4TH ST # C, PERRIS, CA 92570-2125
(951) 943-8899
(951) 943-4598
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0086162
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
10/17/2006
Last updated
08/22/2020
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