Healthcare Provider Details

I. General information

NPI: 1790795458
Provider Name (Legal Business Name): KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 S COURT ST
VISALIA CA
93277-4945
US

IV. Provider business mailing address

400 W MINERAL KING AVE STE 900
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-6090
  • Fax:
Mailing address:
  • Phone: 559-624-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALINDA TUPPER
Title or Position: SR. VP/CFO
Credential:
Phone: 559-624-4065