Organization
HACIENDA VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN S SHIRAZI (CHIEF EXECUTIVE OFFICER)
(951) 683-4056
Entity
Organization
Contact information
Practice address
1435 UNIVERSITY AVE, RIVERSIDE, CA 92507-4466
(951) 683-4056
(951) 788-5352
Mailing address
1435 UNIVERSITY AVE, RIVERSIDE, CA 92507-4466
(951) 683-4056
(951) 788-5352
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
336411358
CA
Other
Enumeration date
01/29/2009
Last updated
01/29/2009
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