MEDICARE: COUNTY OF RIVERSIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	1158 PUBLIC HEALTH	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	05D0571882	OTHER	CA	CLIA #

General Provider Information

NPI Number	:	1952496010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RIVERSIDE

Provider Business Mailing Address
First Line	:	PO BOX 7600
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92513-7600
Country	:	US
Telephone Number	:	951-358-5070
Fax Number	:	951-358-5015

Provider Business Practice Location Address
First Line	:	4065 COUNTY CIRCLE DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3410
Country	:	US
Telephone Number	:	951-358-5070
Fax Number	:	951-358-5015

Authorized Official
Title or Position	:	PUBLIC HEALTH OFFICER
Name	:	GEOFFREY WON-CHEN LEUNG
Credential	:	MD
Telephone Number	:	951-358-5070

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/17/2024

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Directions to “COUNTY OF RIVERSIDE ” Practice Location

Language	Start Address	Practice Location

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