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General NPI Number Information
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NPI Number | 1326530726
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Entity Type | Organization
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Legal Business Name | CCLT MANAGEMENT LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 1004 14TH AVE
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City | DELANO
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State | CA
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Zip | 93215-2246
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Country | US
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Telephone | 661-474-2198
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Fax | 661-474-2601
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Provider Business Mailing Address
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Address Line | 1004 14TH AVE
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City | DELANO
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State | CA
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Zip | 93215-2246
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Country | US
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Telephone | 661-474-2600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WALTER LI
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Credential | PHYSICIAN ASSISTANT
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Telephone | 661-474-2198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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