Healthcare Provider Details

I. General information

NPI: 1508064981
Provider Name (Legal Business Name): CENTRAL CA WOMEN'S FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22
CHOWCHILLA CA
93610-1501
US

IV. Provider business mailing address

9723 MAXINE ST
PICO RIVERA CA
90660-5308
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax:
Mailing address:
  • Phone: 562-949-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number403433
License Number StateCA

VIII. Authorized Official

Name: DR. KUMARI IYER
Title or Position: CMO
Credential:
Phone: 559-665-5531