NPIMap

Organization Active NPI

Southern California Permanente Medical Group

  • Registered Dietitian
  • Riverside, CA
National Provider Identifier
1063279651
Registry record updated Sep 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice address
3951 Van Buren Blvd
Riverside, CA 92503-3620
Phone
(866) 862-4295
NPI assigned
Mar 1, 2024
Last updated
Sep 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Madonna Holbrook-Lowe
Title
Department Administrator
Phone
(951) 233-0023

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

3951 Van Buren Blvd
Riverside, CA 92503-3620

Mailing address

3951 Van Buren Blvd
Riverside, CA 92503-3620
Phone (866) 883-0119

Other identifiers 1

IdentifierTypeStateIssuer
86116023OtherCAREGISTRATION ID NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790726400000",
    "number": "1063279651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3951 VAN BUREN BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033620",
            "telephone_number": "866-883-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3951 VAN BUREN BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033620",
            "telephone_number": "866-862-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-01",
        "last_updated": "2026-09-30",
        "certification_date": "2026-09-30",
        "status": "A",
        "authorized_official_last_name": "HOLBROOK-LOWE",
        "authorized_official_first_name": "MADONNA",
        "authorized_official_title_or_position": "DEPARTMENT ADMINISTRATOR",
        "authorized_official_telephone_number": "951-233-0023"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTRATION ID NUMBER",
            "identifier": "86116023",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.