Healthcare Provider Details

I. General information

NPI: 1124109202
Provider Name (Legal Business Name): CLINICAS DE SALUD DEL PUEBLO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 WINTERHAVEN DRIVE
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

852 E DANENBERG DR.
EL CENTRO CA
92243
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-2700
  • Fax: 760-572-2255
Mailing address:
  • Phone: 760-344-9951
  • Fax: 760-344-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number090000594
License Number StateCA

VIII. Authorized Official

Name: MS. YVONNE BELL
Title or Position: CEO
Credential: MBA
Phone: 760-344-9951