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General NPI Number Information
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NPI Number | 1679200976
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Entity Type | Organization
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Legal Business Name | RIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 66655 MARTINEZ RD
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City | THERMAL
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State | CA
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Zip | 92274-9007
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Country | US
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Telephone | 760-397-4476
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Fax | 951-225-6879
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Provider Business Mailing Address
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Address Line | 11980 MOUNT VERNON AVE
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5172
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Country | US
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Telephone | 909-864-1097
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Fax | 951-225-6879
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM THOMSEN
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Credential |
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Telephone | 909-864-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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