Healthcare Provider Details

I. General information

NPI: 1992183669
Provider Name (Legal Business Name): VALLEY HEALTH TEAM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 07/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 W ASHLAN AVE
FRESNO CA
93722
US

IV. Provider business mailing address

PO BOX 737
SAN JOAQUIN CA
93660-0737
US

V. Phone/Fax

Practice location:
  • Phone: 559-693-2462
  • Fax: 559-892-0322
Mailing address:
  • Phone: 559-693-2462
  • Fax: 559-693-3005

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: MRS. SOYLA R GRIFFIN
Title or Position: CEO
Credential:
Phone: 559-693-2462