Healthcare Provider Details

I. General information

NPI: 1285297754
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: 04/19/2019
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ROSE AVE
SELMA CA
93662-3227
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93722
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone: 800-492-4227
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: MARY LOU LOPEZ
Title or Position: DIRECTOR OF BILLING
Credential: CPC
Phone: 800-492-4227