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NPI Code Detail

MEDICARE: LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC

MEDICARE: LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942503248
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Provider Business Mailing Address
First Line : 931 CHEVY WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4127
Country : US
Telephone Number : 541-535-6239
Fax Number : 541-842-2212
Provider Business Practice Location Address
First Line : 4940 HAMRICK ROAD
Second Line :
City : CENTRAL POINT
State : OR
Zip : 97502-3072
Country : US
Telephone Number : 541-690-3600
Fax Number : 541-664-3735
Authorized Official
Title or Position : CEO
Name : MS. BRENDA IRENE JOHNSON
Credential : RN, MBA
Telephone Number : 541-512-3151
Provider Enumeration Date : 12/09/2010
Last Update Date : 07/15/2019

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Directions to “LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC ” Practice Location

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