Healthcare Provider Details

I. General information

NPI: 1205851151
Provider Name (Legal Business Name): AMPLA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/18/2021
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1574 KIRK RD
GRIDLEY CA
95948-9417
US

IV. Provider business mailing address

PO BOX AD
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 530-846-3707
  • Fax: 530-846-3709
Mailing address:
  • Phone: 530-751-3769
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN H FLORES
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential: MPH
Phone: 530-751-3739