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General NPI Number Information
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NPI Number | 1982992699
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTH CARE
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 532 OAK ST
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City | PARLIER
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State | CA
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Zip | 93648-9658
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Country | US
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Telephone | 559-646-3657
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Fax |
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Provider Business Mailing Address
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Address Line | 532 OAK ST
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City | PARLIER
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State | CA
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Zip | 93648-9658
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Country | US
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Telephone | 559-646-3657
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | ARACELI VILLAGRANA
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Credential | COTA
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Telephone | 559-646-3657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | OTA 1273
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License Number State | CA
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