Healthcare Provider Details

I. General information

NPI: 1669356218
Provider Name (Legal Business Name): EL CERRO PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 W HILLSDALE AVE
VISALIA CA
93291-5118
US

IV. Provider business mailing address

5319 W HILLSDALE AVE
VISALIA CA
93291-5118
US

V. Phone/Fax

Practice location:
  • Phone: 559-471-9803
  • Fax:
Mailing address:
  • Phone: 559-732-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BETHANY
Title or Position: CEO
Credential: DHA
Phone: 559-471-9803