Healthcare Provider Details

I. General information

NPI: 1003672460
Provider Name (Legal Business Name): KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 W CYPRESS AVE
VISALIA CA
93277-1592
US

IV. Provider business mailing address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-3000
  • Fax: 559-635-4747
Mailing address:
  • Phone: 559-624-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALINDA TUPPER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 559-624-4065