Healthcare Provider Details

I. General information

NPI: 1033476197
Provider Name (Legal Business Name): CLINICA DE SALUD DEL VALLE DE SALINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24285 LINCOLN STREET
CHUALAR CA
93925
US

IV. Provider business mailing address

440 AIRPORT BLVD
SALINAS CA
93905-3302
US

V. Phone/Fax

Practice location:
  • Phone: 831-679-0138
  • Fax: 831-678-2803
Mailing address:
  • Phone: 831-679-0138
  • Fax: 831-678-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number070000277
License Number StateCA

VIII. Authorized Official

Name: DR. MAXIMILIANO CUEVAS
Title or Position: CEO
Credential: M.D.
Phone: 831-757-8689