Organization
COUNTY OF RIVERSIDE
Active
Organization
COUNTY OF RIVERSIDE
Active
Other names
La Granada Medical Therapy Unit
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY WON-CHEN LEUNG MD (PHO - ADMIN PHYSICIAN III)
(951) 358-5121
Entity
Organization
Contact information
Practice address
10353 GRAMERCY PL, RIVERSIDE, CA 92505-1334
(951) 687-3113
(951) 359-1747
Mailing address
PO BOX 7600, RIVERSIDE, CA 92513-7600
(951) 358-5401
(951) 358-5150
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CCS00030F
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
11/15/2006
Last updated
10/21/2024
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