Healthcare Provider Details

I. General information

NPI: 1124321583
Provider Name (Legal Business Name): CENTRAL VALLEY INDIAN HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N DEWITT AVE
CLOVIS CA
93612-0311
US

IV. Provider business mailing address

20 N DEWITT AVE
CLOVIS CA
93612-0311
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-4264
  • Fax: 559-299-1421
Mailing address:
  • Phone: 559-299-4264
  • Fax: 559-299-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number20A7366
License Number StateCA

VIII. Authorized Official

Name: NILZA MELLO REICH
Title or Position: PHYSICIAN
Credential: D.O
Phone: 559-299-4264