Healthcare Provider Details

I. General information

NPI: 1063430916
Provider Name (Legal Business Name): DEL PUERTO HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 KEYSTONE PACIFIC PKWY UNIT B
PATTERSON CA
95363-8874
US

IV. Provider business mailing address

PO BOX 187
PATTERSON CA
95363-0187
US

V. Phone/Fax

Practice location:
  • Phone: 209-892-9100
  • Fax: 209-892-9102
Mailing address:
  • Phone: 209-892-8781
  • Fax: 209-892-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. KARIN HENNINGS
Title or Position: CEO ADMINISTRATOR
Credential:
Phone: 209-892-8781