=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699859421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICAS DE SALUD DEL PUEBLO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 283 MAIN ST STE 102
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-2350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-344-3583
-----------------------------------------------------
Fax | 760-344-8480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 852 E DANENBERG DR
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-344-9951
-----------------------------------------------------
Fax | 760-344-5840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | YVONNE BELL
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 760-344-9951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | 090000670
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------