Provider Demographics
NPI:1679954077
Name:RIVERSIDE GASTROENTEROLOGY ASSOCIATES INC.
Entity type:Organization
Organization Name:RIVERSIDE GASTROENTEROLOGY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-788-4400
Mailing Address - Street 1:6958 BROCKTON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3829
Mailing Address - Country:US
Mailing Address - Phone:951-788-3880
Mailing Address - Fax:951-788-3886
Practice Address - Street 1:6958 BROCKTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3829
Practice Address - Country:US
Practice Address - Phone:951-788-3880
Practice Address - Fax:951-788-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty