Riverside-San Bernardino County Indian Health, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Grand Terrace, CA
NPI 1720178478 · NPPES record last updated Jul 7, 2026
Key facts
- NPI
- 1720178478
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 250000055 (CA)
- Legal business name
- RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
- Practice address
- 11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172 - Phone
- (909) 864-1097
- Fax
- (951) 252-6879
- NPI assigned
- Oct 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark Daniel Lebeau
- Title
- Ceo
- Phone
- (909) 864-1097
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 19
Practitioners 27
-
Rizwan Badar, M.D.
-
John Austin Davis, PSY.D.
-
April Michelle Figueroa, FNP-C
-
Ashley Fonseca-Tweed, FNP-BC
-
Sukhdeep K Gill, M.D.
-
Neeza Hassan Kamil, M.D
-
William Kurban, MD
-
Pamela Enjema Mokoko, FAMILY NURSE PRACTIT
-
William Howard Park, O.D.
-
Cara Ann Semino, OD
-
Jessica Talbot, FNP
-
Glen Wiley, APRN, FNP-C
-
Karen Joan Melde, NP
-
Afua I Khumalo, RD
-
Ruth A Ogot, DNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150508001121 | TX | Part B Supplier - Clinic/Group Practice | 4789867805 |
Receives reassigned benefits from 98 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Thermal, CA; Temecula, CA; San Jacinto, CA; Grand Terrace, CA; Mountain Center, CA; Anza, CA; Barstow, CA; Banning, CA |
National Provider Directory
- Tax ID family
- Riverside San Bernandin
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 240000751 | CA | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | 250000055 | CA | Yes |
Addresses
Primary practice location
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Mailing address
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC03869F | Medicaid | CA | |
| FHC03854F | Medicaid | CA | |
| FHC70271F | Medicaid | CA | |
| EAP03854F | Other | CA | EAPC |
Other providers in Grand Terrace, CA
- Jennifer Reyes
- Denise Reynolds
- Rise Forward Speech Therapy, Inc
- Riverside-San Bernardino County Indian Health Inc
- Riverside-San Bernardino County Indian Health, Inc.
- Riverside-San Bernardino County Indian Health, Inc.
- Lynette J. Rivinius
- Cristina Rodriguez
- Geraldyn Reyes Bandola Sabalboro
- Michelle Sabino
All providers in Grand Terrace, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.