1558638601 NPI number — VALLEY HEALTH TEAM, INC.

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 1558638601 NPI number — VALLEY HEALTH TEAM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY HEALTH TEAM, INC.
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:
FIREBAUGH COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1558638601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 737
Provider Second Line Business Mailing Address:
21890 COLORADO AVE
Provider Business Mailing Address City Name:
SAN JOAQUIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93660-0737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-693-2462
Provider Business Mailing Address Fax Number:
559-693-4382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
689 N ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIREBAUGH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93622-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-693-2462
Provider Business Practice Location Address Fax Number:
559-659-3464
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REYNA-GRIFFIN
Authorized Official First Name:
SOYLA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
559-693-2462

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  550001856 , 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)





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