Provider Demographics
NPI:1669356069
Name:GREENRIVER MEDICAL GROUP & PALLIATIVE CARE
Entity type:Organization
Organization Name:GREENRIVER MEDICAL GROUP & PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-873-5668
Mailing Address - Street 1:3317 DEAVER DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8791
Mailing Address - Country:US
Mailing Address - Phone:714-873-5668
Mailing Address - Fax:
Practice Address - Street 1:3317 DEAVER DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8791
Practice Address - Country:US
Practice Address - Phone:714-873-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty