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General NPI Number Information
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NPI Number | 1629861182
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Entity Type | Organization
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Legal Business Name | LA CLINICA DEL VALLE FAMILY HEALTHCARE CENTER INC.
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 225 OAK ST
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City | ROGUE RIVER
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State | OR
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Zip | 97537-9567
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Country | US
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Telephone | 541-507-8550
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Fax | 541-494-1789
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Provider Business Mailing Address
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Address Line | 931 CHEVY WAY
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City | MEDFORD
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State | OR
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Zip | 97504-4127
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Country | US
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Telephone | 541-535-6239
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE MANAGER
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Name | SOCHIL M CASTILLO
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Credential |
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Telephone | 541-512-3127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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