TRICITY RIVERSIDE DIALYSIS (NPI# 1003396615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003396615 |
| Entity Type | Organization |
| Organization Name | TRICITY RIVERSIDE DIALYSIS |
| Practice Address |
7275 Indiana Ave Riverside CA 92504-4543 |
| Mailing Address |
3595 Van Buren Blvd Ste 203 Riverside CA 92503-0311 |
| Practice Telephone | 9513431978 |
| Mailing Telephone | 9513431978 |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2019-03-25 |
| Authorized Official Name | DR. MOHAMMED QUTUB KHAN (PRESIDENT) |
| Authorized Official Telephone | 9513431978 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Street Address |
7275 INDIANA AVE |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92504-4543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417573676 | Chloe Ivana Licon | Marriage & Family Therapist | New Beginnings Residential Treatment Facilities, 2900 Adams St, Riverside, CA 92504 | 2020-06-23 |
| 1720628993 | Palm Lily LLC | Non-emergency Medical Transport (VAN) | 2900 Adams Street Suite A435, Riverside, CA 92504 | 2020-01-15 |
| 1538630959 | Just for Kids Pediatric Dentistry Raymond Wang | Dentist | 7071 Indiana Ave, Riverside, CA 92504 | 2018-12-11 |
| 1477047835 | Deborah Kay Allen | Peer Specialist | 6939 Morningside Ave, Riverside, CA 92504 | 2018-06-19 |
| 1255833794 | Adiana Loya | Student in an Organized Health Care Education/Training Program | 7550 Orchard St Apt #58, Riverside, CA 92504 | 2018-03-01 |
| 1023524162 | Chiara Heyer | Counselor | 4130 Adams St Ste B, Riverside, CA 92504 | 2017-12-27 |
| 1801313408 | Gustavo Gallo Avelar | Behavioral Analyst | 4125 Rucker Ln, Riverside, CA 92504 | 2017-08-24 |
| 1891226205 | Susana Herold | Assistant Behavior Analyst | 17460 Krameria Ave, Riverside, CA 92504 | 2017-03-27 |
| 1710356167 | Erandi Portugal | Counselor | 6711 Alrington Avenue, Riverside, CA 92504 | 2015-09-16 |
| 1548636012 | Candace Lauren Bynder | Counselor | 6711 Arlington Avenue, Riverside, CA 92504 | 2015-08-19 |
| Find all providers in zip 92504 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215332945 | Iroquois Dialysis LLC | Clinic/Center | 3660 Park Sierra Dr Ste 103, Riverside, CA 92505-3071 | 2014-10-23 |
| 1306240551 | Iroquois Dialysis LLC | Clinic/Center | 3660 Park Sierra Dr Ste 108, Riverside, CA 92505-3071 | 2014-10-17 |
| 1538271333 | Bio-medical Applications of California Inc | Clinic/Center | 3470 La Sierra Ave Ste E, Riverside, CA 92503-5223 | 2006-08-31 |
| 1316971641 | Davita Riverside II LLC | Clinic/Center | 11161 Magnolia Ave, Riverside, CA 92505-3605 | 2006-07-11 |
| 1033172135 | Renal Treatment Centers California Inc | Clinic/Center | 4361 Latham St Ste 100, Riverside, CA 92501-1767 | 2006-04-10 |
| 1245567627 | Mk Dialysis Center At Riverside, Inc. | Clinic/Center | 3595 Van Buren Blvd, Suite 101, Riverside, CA 92503-0311 | 2009-11-05 |
| 1144427741 | Namg Home Dialysis LLC | Clinic/Center | 3660 Park Sierra Dr, Ste 103, Riverside, CA 92505-3081 | 2007-06-28 |
| 1013119064 | Namg Home Dialysis LLC | Clinic/Center | 3660 Park Sierra Dr, Ste 108, Riverside, CA 92505-3081 | 2007-06-01 |
| 1922153576 | Kaiser Foundation Hospitals | Clinic/Center | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2007-01-24 |
| 1811941891 | Riverside Healthcare System, L.p. | Clinic/Center | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2006-05-22 |
| Find all providers in RIVERSIDE | ||||
Please comment or provide details below to improve the information on TRICITY RIVERSIDE DIALYSIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.