Healthcare Provider Details

I. General information

NPI: 1992142277
Provider Name (Legal Business Name): WEST SIDE HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E NORTH ST
TAFT CA
93268-3606
US

IV. Provider business mailing address

119 ADKISSON WAY
TAFT CA
93268-3602
US

V. Phone/Fax

Practice location:
  • Phone: 661-765-1935
  • Fax: 661-765-1928
Mailing address:
  • Phone: 661-765-7234
  • Fax: 661-745-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN L SHULTZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-765-7234