Healthcare Provider Details

I. General information

NPI: 1861305443
Provider Name (Legal Business Name): M A C T HEALTH BOARD, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SYLVA LN STE K1
SONORA CA
95370-5969
US

IV. Provider business mailing address

PO BOX 939
ANGELS CAMP CA
95222-0939
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6262
  • Fax:
Mailing address:
  • Phone: 209-754-6262
  • Fax: 209-736-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARIELA CONTRERAS
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 209-754-6262