Healthcare Provider Details

I. General information

NPI: 1679654750
Provider Name (Legal Business Name): CLINICAS DE SALUD DEL PUEBLO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8027 US HWY 111
NILAND CA
92257
US

IV. Provider business mailing address

852 E DANENBERG DR
EL CENTRO CA
92243
US

V. Phone/Fax

Practice location:
  • Phone: 760-359-0110
  • Fax: 760-359-3629
Mailing address:
  • Phone: 760-344-9951
  • Fax: 760-344-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number090000456
License Number StateCA

VIII. Authorized Official

Name: MS. YVONNE BELL
Title or Position: CEO
Credential: MBA
Phone: 760-344-9951