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Organization
QUALITY LIFE PSYCHIATRIC & PSYCHOLOGICAL GROUP, INC.
Active
Organization
QUALITY LIFE PSYCHIATRIC & PSYCHOLOGICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD T KOTOMORI JR. M.D (CEO)
(951) 684-2627
Entity
Organization
Contact information
Practice address
6529 RIVERSIDE AVE, SUITE 133, RIVERSIDE, CA 92506-3122
(951) 684-2627
(951) 788-5837
Mailing address
6529 RIVERSIDE AVE, SUITE 133, RIVERSIDE, CA 92506-3122
(951) 684-2627
(951) 788-5837
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY19090
CA
103T00000X
Psychologist
PSY8086
CA
103TC0700X
Clinical Psychologist
PSY 9633
CA
106H00000X
Marriage & Family Therapist
MFC 40326
CA
106H00000X
Marriage & Family Therapist
MFC39054
CA
106H00000X
Marriage & Family Therapist
MFT 18385
CA
2084P0800X
Psychiatry Physician
A30827
CA
2084P0800X
Psychiatry Physician
A41330
CA
2084P0800X
Psychiatry Physician
Primary
A60376
CA
Other
Enumeration date
11/29/2006
Last updated
06/28/2012
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