Healthcare Provider Details

I. General information

NPI: 1497931828
Provider Name (Legal Business Name): AMPLA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 PUTNAM WAY
ARBUCKLE CA
95912-9814
US

IV. Provider business mailing address

935 MARKET ST
YUBA CITY CA
95991-4217
US

V. Phone/Fax

Practice location:
  • Phone: 530-476-2200
  • Fax: 530-476-2201
Mailing address:
  • Phone: 530-751-3769
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550000669
License Number StateCA

VIII. Authorized Official

Name: MR. BENJAMIN H FLORES
Title or Position: PRESIDENT, CHIEF EXECUTIVE OFFICER
Credential: MPH
Phone: 530-751-3739