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6833 Indiana Ave Ste 101 Riverside CA 92506-4223 | |
| (951) 289-5424 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 6833 Indiana Ave Ste 101, Riverside, California |
| Authorized Official Name and Position | Deepak Rajpoot (CEO) |
| Authorized Official Contact | 7755507401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
806 Avenida Pico # I-330 San Clemente CA 92673-5639 Ph: (657) 346-6319 | 6833 Indiana Ave Ste 101 Riverside CA 92506-4223 Ph: (951) 289-5424 |
| NPI Number | 1194479501 |
|---|---|
| Provider Enumeration Date | 02/05/2022 |
| Last Update Date | 02/06/2025 |
| Certification Date | 02/06/2025 |
| Medicare PECOS PAC ID | 8820482805 |
|---|---|
| Medicare Enrollment ID | O20220309000254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194479501 | NPI | - | NPPES |
| Provider Name | Mark D Peterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396786620 PECOS PAC ID: 2567492424 Enrollment ID: I20050819000565 |
| Provider Name | Thomas J Grayden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700942117 PECOS PAC ID: 2264526599 Enrollment ID: I20070918000406 |
| Provider Name | Samantha J Perkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790023281 PECOS PAC ID: 5890929236 Enrollment ID: I20150831000820 |
| Provider Name | Parvez P Jessani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134202849 PECOS PAC ID: 5294728150 Enrollment ID: I20160915001315 |
| Provider Name | David Walsh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730590886 PECOS PAC ID: 4688931744 Enrollment ID: I20171127002823 |
| Provider Name | Brian Choi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285054890 PECOS PAC ID: 6103123294 Enrollment ID: I20180725001074 |
| Provider Name | Andia Heydari Turner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407210875 PECOS PAC ID: 0648525642 Enrollment ID: I20180921001885 |
| Provider Name | Deepak Rajpoot |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093942864 PECOS PAC ID: 7012184534 Enrollment ID: I20190111002684 |
| Provider Name | Jordanne Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902361785 PECOS PAC ID: 7719229350 Enrollment ID: I20190430001752 |
| Provider Name | Cristina Gonzales Pajarillaga-encello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417511650 PECOS PAC ID: 9931536372 Enrollment ID: I20200225002397 |
| Provider Name | Dominique L Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124589163 PECOS PAC ID: 5890123186 Enrollment ID: I20200320000233 |
| Provider Name | Stephanie Lei |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457640997 PECOS PAC ID: 1951654425 Enrollment ID: I20220404001223 |
| Provider Name | Trevor Curry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922699065 PECOS PAC ID: 9335511310 Enrollment ID: I20230221002203 |
| Provider Name | Jennifer Hong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609458132 PECOS PAC ID: 7315310158 Enrollment ID: I20230227001498 |
| Provider Name | Summer Jay Langley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689706509 PECOS PAC ID: 3274987342 Enrollment ID: I20230922001418 |
| Provider Name | Rachel Elizabeth Fernelius |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679356406 PECOS PAC ID: 5395199491 Enrollment ID: I20230922002757 |
| Provider Name | Krystal Faye Saum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952090425 PECOS PAC ID: 6204281959 Enrollment ID: I20231016002393 |
| Provider Name | Fernando Ortega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164118956 PECOS PAC ID: 3779939442 Enrollment ID: I20231101001157 |
| Provider Name | Leticia Isabel Ortega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427745447 PECOS PAC ID: 9830545516 Enrollment ID: I20231101001670 |
| Provider Name | Won I Choi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689683872 PECOS PAC ID: 9739523978 Enrollment ID: I20240215003655 |
| Provider Name | Kathryn Frances Lunny |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750843868 PECOS PAC ID: 0042698540 Enrollment ID: I20240215004056 |
| Provider Name | Todd Eisenberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477696409 PECOS PAC ID: 4385732718 Enrollment ID: I20240329001117 |
| Provider Name | Sandra Miyakawa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184488488 PECOS PAC ID: 0840638748 Enrollment ID: I20240410002012 |
| Provider Name | Sofia Lucina Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104672930 PECOS PAC ID: 9638611528 Enrollment ID: I20240606002800 |
| Provider Name | Tamekia Flanngan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336633221 PECOS PAC ID: 2062854854 Enrollment ID: I20240624000505 |
| Provider Name | Giovanni Villegas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629607908 PECOS PAC ID: 4688112535 Enrollment ID: I20240809003845 |
| Provider Name | Waylon Whitley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952091811 PECOS PAC ID: 3173062676 Enrollment ID: I20240828003347 |
| Provider Name | Jessica Nohemy Sanchez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275097404 PECOS PAC ID: 3375084643 Enrollment ID: I20240926002034 |
| Provider Name | Ann Huynh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699540880 PECOS PAC ID: 5496286023 Enrollment ID: I20241007001138 |
| Provider Name | Jessica M Giron |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1992969752 PECOS PAC ID: 0840725552 Enrollment ID: I20241118004153 |
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