| Soboba Indian Health | |
|
23119 Soboba Way San Jacinto CA 92583-5517 | |
| (951) 676-6810 | |
| (951) 676-0744 |
| Full Name | Soboba Indian Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 23119 Soboba Way, San Jacinto, California |
| Authorized Official Name and Position | William Thomsen (CEO) |
| Authorized Official Contact | 9098641097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soboba Indian Health 11980 Mount Vernon Ave Grand Terrace CA 92313-5172 Ph: (909) 864-1097 | Soboba Indian Health 23119 Soboba Way San Jacinto CA 92583-5517 Ph: (951) 676-6810 |
| NPI Number | 1639222144 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 04/17/2023 |
| Medicare PECOS PAC ID | 4789867805 |
|---|---|
| Medicare Enrollment ID | O20110429000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639222144 | NPI | - | NPPES |
| FHC70271F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 250000055 (California) | Primary |
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