1417939968 NPI number — UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417939968 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:
1417939968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-646-3561
Provider Business Mailing Address Fax Number:
559-646-6915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
476 E WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EARLIMART
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-849-2781
Provider Business Practice Location Address Fax Number:
661-849-5719
Provider Enumeration Date:
11/18/2005

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351 . This is a "HEALTH NET MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 341 . This is a "BLUE CROSS MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC03861F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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