Healthcare Provider Details

I. General information

NPI: 1346268190
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 INDIANA AVE
RIVERSIDE CA
92504-4544
US

IV. Provider business mailing address

PO BOX 7849
RIVERSIDE CA
92513-7849
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6000
  • Fax: 951-358-6044
Mailing address:
  • Phone: 951-358-5222
  • Fax: 951-358-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA81828
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL TWEEDELL
Title or Position: DEPUTY DIRECTOR
Credential: M.P.H.
Phone: 951-358-5222