Healthcare Provider Details

I. General information

NPI: 1508465303
Provider Name (Legal Business Name): VALLEY HEALTH TEAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 W LINE ST STE C
BISHOP CA
93514-3333
US

IV. Provider business mailing address

PO BOX 737
SAN JOAQUIN CA
93660-0737
US

V. Phone/Fax

Practice location:
  • Phone: 760-784-7020
  • Fax: 559-326-5323
Mailing address:
  • Phone: 559-693-2462
  • Fax: 559-693-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SOYLA A. REYNA-GRIFFIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: C.P.A.
Phone: 559-693-2462