MEDICARE: COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY

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	207Q00000X	Family Medicine Physician	C28415	CA
2	261QF0400X	Federally Qualified Health Center (FQHC)		CA

General Provider Information

NPI Number	:	1417975269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY

Provider Business Mailing Address
First Line	:	PO BOX 7849
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92513-7849
Country	:	US
Telephone Number	:	951-358-5222
Fax Number	:	951-358-5235

Provider Business Practice Location Address
First Line	:	47923 OASIS ST
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-6950
Country	:	US
Telephone Number	:	760-863-8283
Fax Number	:	760-863-8366

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	MR. MICHAEL TWEEDELL
Credential	:	M.P.H.
Telephone Number	:	951-358-5222

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	09/11/2025

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