PATHOLOGY MEDICAL GROUP OF RIVERSIDE (NPI# 1417016833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417016833 |
| Entity Type | Organization |
| Organization Name | PATHOLOGY MEDICAL GROUP OF RIVERSIDE |
| Practice Address |
4445 Magnolia Ave Riverside Community Hospital Riverside CA 92501 |
| Mailing Address |
Po Box 260071 Saint Louis MO 63126-8071 |
| Practice Telephone | 9517883243 |
| Practice Fax Number | 9517883633 |
| Mailing Telephone | 3148493535 |
| Mailing Fax Number | 8444103800 |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2019-11-27 |
| Authorized Official Name | DR. DARREN OKADA (OWNER - MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9517883243 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0087630 | 05 |
| Street Address |
4445 MAGNOLIA AVE RIVERSIDE COMMUNITY HOSPITAL |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801897731 | Donald R Massee | Radiology | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2005-08-02 |
| 1215538392 | Nicole Barnard | Nurse Practitioner | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-11-04 |
| 1942808811 | Nelson Javier Maravilla | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-10-13 |
| 1801494026 | Clinton William Hart | Nurse Practitioner | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-10-09 |
| 1578179677 | Dallas Mckinley Bessette | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-09-23 |
| 1124641444 | Emely Rebekah Garcia | Anesthesiology | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-05-20 |
| 1447872429 | Seena Khosravi | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-12 |
| 1336761519 | Alexandra May Bock | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-05-11 |
| 1568084747 | Courtney Lynn Hipkin | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-11 |
| 1003438193 | Shalini Sunil Shah | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700437605 | Mary Horvatin | Technician | 1811 Rivera Strret, Riverside, CA 92501 | 2019-09-23 |
| 1366905473 | Timothy Daniel Collins | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme, Office, Riverside, CA 92501 | 2019-04-08 |
| 1346709672 | Lourdes Adame | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave - Gme Office, Riverside, CA 92501 | 2019-03-16 |
| 1740759067 | Kristina Ferris-celosse | Counselor | 2452 Wilshire St., Riverside, CA 92501 | 2018-11-15 |
| 1750888095 | Arunmozhi Aravagiri | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, Gme Office, 4445 Magnolia Ave., Riverside, CA 92501 | 2018-04-12 |
| 1720585847 | Alan Huynh | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue., Gme Office, Riverside, CA 92501 | 2018-04-06 |
| 1538664834 | Wilson Paul Frasca | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue, Riverside, CA 92501 | 2018-03-28 |
| 1851896575 | Geethu Gopinathan Nair | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme Office, Riverside, CA 92501 | 2018-03-26 |
| 1316465560 | Thilini Anne Abeygunaratne | Marriage & Family Therapist | 1950 Market Street, Riverside, CA 92501 | 2017-09-07 |
| 1194257410 | Melissa Chitwood | Assistant Behavior Analyst | 3078 Cedar St., Riverside, CA 92501 | 2017-03-28 |
| Find all providers in zip 92501 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861609893 | Joseph Tin Cheuk Tang | Pathology | 9380 Magnolia Avenue, Riverside, CA 92503 | 2007-05-17 |
| 1548313273 | Ralph A Korpman | Pathology | 4505 Allstate Dr, Suite 216, Riverside, CA 92501-1799 | 2007-01-18 |
| 1770999088 | Stanley Kwong | Pathology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2014-07-08 |
| 1518239441 | Kristina Diane Cendrowski | Pathology | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2012-02-08 |
| 1023276771 | Michelle Lori Meyer | Pathology | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2008-05-29 |
| 1700080835 | Maria I Salcedo | Pathology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2007-06-13 |
| 1134245921 | Darren Okada | Pathology | 4445 Magnolia Ave, Dept of Pathology, Riverside Community Hospital, Riverside, CA 92501-4135 | 2007-03-22 |
| 1194892901 | Dong A. Quach | Pathology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2006-11-29 |
| 1073680880 | Mark T. Taira | Pathology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2006-11-29 |
| 1942372271 | Anh Huynh Phan | Pathology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2006-11-14 |
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| 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.