Healthcare Provider Details

I. General information

NPI: 1295944015
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: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BARBOZA ST
MENDOTA CA
93640-1901
US

IV. Provider business mailing address

PO BOX 790
PARLIER CA
93648-0790
US

V. Phone/Fax

Practice location:
  • Phone: 559-655-5000
  • Fax: 559-655-6818
Mailing address:
  • Phone: 559-646-3561
  • Fax: 559-646-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN H FLORES
Title or Position: CEO
Credential:
Phone: 559-646-6618