Healthcare Provider Details

I. General information

NPI: 1376566133
Provider Name (Legal Business Name): KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W WILLOW AVE STE A
VISALIA CA
93291-6102
US

IV. Provider business mailing address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2000
  • Fax: 559-713-2356
Mailing address:
  • Phone: 559-624-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHE39929
License Number StateCA

VIII. Authorized Official

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