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General NPI Number Information
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NPI Number | 1831623453
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Entity Type | Organization
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Legal Business Name | DOS PALOS APEX HEALTH CENTER INC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 1549 GOLDEN GATE ST.
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City | DOS PALOS
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State | CA
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Zip | 93620-2329
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Country | US
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Telephone | 209-392-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 1549 GOLDEN GATE AVE
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City | DOS PALOS
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State | CA
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Zip | 93620-2329
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Country | US
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Telephone | 209-392-0022
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KARTHIKEYA DEVIREDDY
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Credential |
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Telephone | 209-392-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 3992639
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License Number State | CA
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