Healthcare Provider Details

I. General information

NPI: 1811958952
Provider Name (Legal Business Name): MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAWS AVE
UKIAH CA
95482-6540
US

IV. Provider business mailing address

333 LAWS AVE
UKIAH CA
95482-6540
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-1010
  • Fax: 707-468-0174
Mailing address:
  • Phone: 707-468-1010
  • Fax: 707-468-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANTONIA DELGADO VEGA
Title or Position: BILLING MANAGER
Credential:
Phone: 707-467-2260