Healthcare Provider Details

I. General information

NPI: 1487855045
Provider Name (Legal Business Name): RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/11/2025
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23119 SOBOBA WAY
SAN JACINTO CA
92583-5517
US

IV. Provider business mailing address

11980 MOUNT VERNON AVE
GRAND TERRACE CA
92313-5172
US

V. Phone/Fax

Practice location:
  • Phone: 951-654-0803
  • Fax: 951-654-9387
Mailing address:
  • Phone: 909-864-1097
  • Fax: 951-225-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEEVAN DHOUNI
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 909-864-1097