1740139666 NPI number — SHEPHERDS HEART CENTRAL 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 1740139666 NPI number — SHEPHERDS HEART CENTRAL VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEPHERDS HEART CENTRAL 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:
1740139666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8881 E LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOWLER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93625-9521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-288-2841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8881 E LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOWLER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93625-9521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-288-2841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2026

Additional Information

Authorized Official

Authorized Official Last Name:
OTERO
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
951-288-2841

Provider Taxonomy Codes

  • Taxonomy code: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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