Healthcare Provider Details

I. General information

NPI: 1902897218
Provider Name (Legal Business Name): CLINICAS DE SALUD DEL PUEBLO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91275 66TH AVE. SUITE 300
MECCA CA
92254
US

IV. Provider business mailing address

1166 K ST P.O. BOX 1279
BRAWLEY CA
92227-2737
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-1249
  • Fax: 760-396-1253
Mailing address:
  • Phone: 760-344-9951
  • Fax: 760-344-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. YVONNE BELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-344-9951