Healthcare Provider Details

I. General information

NPI: 1326262965
Provider Name (Legal Business Name): FIREBAUGH AND MENDOTA HEALTH CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 O ST
FIREBAUGH CA
93622-2221
US

IV. Provider business mailing address

2057 HIGH ST
SELMA CA
93662-3512
US

V. Phone/Fax

Practice location:
  • Phone: 559-659-3011
  • Fax: 559-659-3065
Mailing address:
  • Phone: 559-891-9100
  • Fax: 559-891-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MISS ISELA M HARO
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-449-1370