Healthcare Provider Details

I. General information

NPI: 1952832032
Provider Name (Legal Business Name): SARIN & TAO FAMILY MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 PINE AVE
HOLTVILLE CA
92250-1121
US

IV. Provider business mailing address

529 PINE AVE
HOLTVILLE CA
92250-1121
US

V. Phone/Fax

Practice location:
  • Phone: 760-756-3172
  • Fax: 469-501-9146
Mailing address:
  • Phone: 760-756-3172
  • Fax: 469-501-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. VINCENT V SOUN
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 760-756-3172