Healthcare Provider Details

I. General information

NPI: 1932523149
Provider Name (Legal Business Name): AVENAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E KINGS ST
AVENAL CA
93204-1529
US

IV. Provider business mailing address

P O BOX 547
AVENAL CA
93272
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-9000
  • Fax:
Mailing address:
  • Phone: 559-386-9000
  • Fax: 559-386-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. LINDA ROBERTS
Title or Position: OWNER/ADMINISTRATORS
Credential: RN
Phone: 559-752-4147