| Hacienda Village | |
|
1435 University Ave Riverside CA 92507-4466 | |
| (951) 683-4056 | |
| (951) 788-5352 |
| Full Name | Hacienda Village |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1435 University Ave, Riverside, California |
| Authorized Official Name and Position | Shawn S Shirazi (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9516834056 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hacienda Village 1435 University Ave Riverside CA 92507-4466 Ph: (951) 683-4056 | Hacienda Village 1435 University Ave Riverside CA 92507-4466 Ph: (951) 683-4056 |
| NPI Number | 1255579215 |
|---|---|
| Provider Enumeration Date | 01/29/2009 |
| Last Update Date | 01/29/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255579215 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 336411358 (California) | Primary |
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