Healthcare Provider Details

I. General information

NPI: 1285667758
Provider Name (Legal Business Name): AMPLA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CORTINA DR
ORLAND CA
95963-1699
US

IV. Provider business mailing address

PO BOX AD
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 530-865-5544
  • Fax: 530-865-9209
Mailing address:
  • Phone: 530-751-3778
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number230000102
License Number StateCA

VIII. Authorized Official

Name: MR. BENJAMIN H FLORES
Title or Position: PRESIDENT, CHIEF EXECUTIVE OFFICER
Credential: MPH
Phone: 530-751-3778