Organization
TRICITY RIVERSIDE DIALYSIS
Active
Organization
TRICITY RIVERSIDE DIALYSIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED QUTUB KHAN MD (PRESIDENT)
(951) 343-1978
Entity
Organization
Contact information
Practice address
7275 INDIANA AVE, RIVERSIDE, CA 92504-4543
(951) 343-1978
Mailing address
3595 VAN BUREN BLVD STE 203, RIVERSIDE, CA 92503-0311
(951) 343-1978
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
08/14/2018
Last updated
03/25/2019
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