1710196670 NPI number — UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY

Table of content: (NPI 1710196670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710196670 NPI number — UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710196670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARLIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93648-0790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-646-3561
Provider Business Mailing Address Fax Number:
559-646-3642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 S MADERA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93630-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-846-6330
Provider Business Practice Location Address Fax Number:
559-846-5553
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
559-646-6618

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341 . This is a "BLUE CROSS MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 351 . This is a "HEALTH NET MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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