Healthcare Provider Details

I. General information

NPI: 1972129112
Provider Name (Legal Business Name): UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E SHIELDS AVE STE 103
FRESNO CA
93726-5313
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone: 800-492-4227
  • Fax: 559-646-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY LOU LOPEZ
Title or Position: DIRECTOR OF CENTRAL OPERATIONS
Credential:
Phone: 800-492-4227