Healthcare Provider Details

I. General information

NPI: 1104331586
Provider Name (Legal Business Name): VO NEIGHBORHOOD MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E COLE BLVD
CALEXICO CA
92231-3211
US

IV. Provider business mailing address

222 E COLE BLVD
CALEXICO CA
92231-3211
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-2551
  • Fax: 760-352-3022
Mailing address:
  • Phone: 760-352-2551
  • Fax: 760-352-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIEN VO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 442-283-3494