Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Active
Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Active
Other names
San Manuel Indian Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DANIEL LEBEAU (CEO)
(909) 864-1097
Entity
Organization
Contact information
Practice address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(909) 744-3960
Mailing address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(909) 744-3960
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
240000751
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC03869F
—
CA
Enumeration date
01/19/2007
Last updated
07/07/2026
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