Healthcare Provider Details

I. General information

NPI: 1619952397
Provider Name (Legal Business Name): TUOLUMNE MEWUK INDIAN HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18880 CHERRY VALLEY BLVD
TUOLUMNE CA
95379-9612
US

IV. Provider business mailing address

18880 CHERRY VALLEY BLVD
TUOLUMNE CA
95379-9506
US

V. Phone/Fax

Practice location:
  • Phone: 209-928-5450
  • Fax: 209-928-5414
Mailing address:
  • Phone: 209-928-5400
  • Fax: 209-928-5414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY18496
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG73139
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG32948
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53764
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7824
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA62628
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP14383
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15883
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG50654
License Number StateCA

VIII. Authorized Official

Name: BECKY SHOKRAII
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 209-459-7933