RIVERSIDE/SAN BERNARDINO COUNTY INDIAN HEALTH, INC. (NPI# 1386837227) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386837227 |
| Entity Type | Organization |
| Organization Name | RIVERSIDE/SAN BERNARDINO COUNTY INDIAN HEALTH, INC. |
| Other Organization Name | SOBOBA INDIAN HEALTH CLINIC |
| Practice Address |
607 Donna Way San Jacinto CA 92583-5517 |
| Mailing Address |
11555 Potrero Rd Banning CA 92220-6946 |
| Practice Telephone | 9516540803 |
| Practice Fax Number | 9516549387 |
| Mailing Telephone | 9518494761 |
| Mailing Fax Number | 9518495612 |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2007-08-23 |
| Authorized Official Name | MR. LINWWOD J KILLAM (CEO) |
| Authorized Official Telephone | 9518494761 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC70271F | 05 | |
| CA | BCP70271F | 05 |
| Other Name | Type Code |
|---|---|
| Soboba Indian Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720178478 | Riverside/san Bernardino County Indian Health, Inc. | Clinic/Center | 11555 1/2 Potrero Rd, Banning, CA 92220-6946 | 2006-10-13 |
| Street Address |
607 DONNA WAY |
| City | SAN JACINTO |
| State | CA |
| Zip Code | 92583-5517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407856206 | Debora Shaleen Potalivo | Chiropractor | 607 Donna Way, San Jacinto, CA 92583-5517 | 2005-07-22 |
| 1306456850 | Maiya Renee Cooper | Optometrist | 607 Donna Way, San Jacinto, CA 92583-5517 | 2020-08-07 |
| 1609347897 | Fabian De Anda | Driver | 607 Donna Way, San Jacinto, CA 92583-5517 | 2018-12-16 |
| 1114439155 | Dalila Isabel Ruiz | Nutritionist | 607 Donna Way, San Jacinto, CA 92583-5517 | 2017-10-31 |
| 1962926402 | Angella Leonie White | Registered Nurse | 607 Donna Way, San Jacinto, CA 92583-5517 | 2017-07-26 |
| 1699179861 | Anthony Mazza | Nutritionist | 607 Donna Way, San Jacinto, CA 92583-5517 | 2014-10-17 |
| 1144648908 | Nadin Mansour | Pediatrics | 607 Donna Way, San Jacinto, CA 92583-5517 | 2014-03-30 |
| 1760829543 | Mary Madrigal Sandoval | Registered Nurse | 607 Donna Way, San Jacinto, CA 92583-5517 | 2013-06-03 |
| 1740556075 | Lindsay Koh | Dietitian, Registered | 607 Donna Way, San Jacinto, CA 92583-5517 | 2012-03-30 |
| 1891090692 | Jennifer Eimers | Dietitian, Registered | 607 Donna Way, Soboba Indian Health, San Jacinto, CA 92583-5517 | 2011-01-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306459615 | Walgreen Co | Pharmacy | 23335 Soboba Rd, San Jacinto, CA 92583 | 2020-08-26 |
| 1295399632 | Suhaila Mahjabeen Arif | Student in an Organized Health Care Education/Training Program | 651 North State Street, San Jacinto, CA 92583 | 2019-04-30 |
| 1083146328 | United Family Pharmacy, LLC | Pharmacy | 1221 S. San Jacinto Ave, San Jacinto, CA 92583 | 2017-03-28 |
| 1699127118 | Matthew Siragusa | Dental Assistant | 792 Salinger Pl, San Jacinto, CA 92583 | 2016-07-08 |
| 1326431966 | Empire Mobility | Durable Medical Equipment & Medical Supplies | 1499 Old Mountain Ave, Spc127, San Jacinto, CA 92583 | 2015-03-06 |
| 1598102485 | Ribhi A Hamad | Pharmacist | 1181 N Sate St, San Jacinto, CA 92583 | 2013-05-31 |
| 1770831489 | Neelam Gupta M.d. Inc. | Clinic/Center | 343 E Main Street, 106, San Jacinto, CA 92583 | 2012-08-28 |
| 1407154040 | Elizabeth Santillana Contla | Registered Nurse | 1370 S. State Street, Ste B, San Jacinto, CA 92583 | 2011-03-07 |
| 1902125636 | Tonnette Na Ellis | Counselor | 1854 Hemet St, San Jacinto, CA 92583 | 2010-05-20 |
| 1851525315 | Lydia Meria Reece | Physician Assistant | 229 West 7th Street, San Jacinto, CA 92583 | 2009-05-12 |
| Find all providers in zip 92583 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598180101 | Borrego Community Health Foundation | Clinic/Center | 651 N State St, San Jacinto, CA 92583-6573 | 2014-02-19 |
| 1639222144 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 607 Donna Way, San Jacinto, CA 92583-5517 | 2007-01-19 |
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| Find all providers with the same taxonomy | ||||
| City | SAN JACINTO |
| Zip Code | 92583 |
Please comment or provide details below to improve the information on RIVERSIDE/SAN BERNARDINO COUNTY INDIAN HEALTH, INC..
| 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.