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NPI Code Detail

MEDICARE: CLINICAS DE SALUD DEL PUEBLO, INC

MEDICARE: CLINICAS DE SALUD DEL PUEBLO, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)250000024CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2HAP03863FOTHERCAFAMILY PACT
3BCP03863FOTHERCACANCER DETECTION PROGRAM

General Provider Information

NPI Number : 1124115431
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICAS DE SALUD DEL PUEBLO, INC
Provider Business Mailing Address
First Line : 852 E DANENBERG DR
Second Line :
City : EL CENTRO
State : CA
Zip : 92243
Country : US
Telephone Number : 760-344-9951
Fax Number : 760-344-5840
Provider Business Practice Location Address
First Line : 1415 W HOBSONWAY
Second Line :
City : BLYTHE
State : CA
Zip : 92225-1479
Country : US
Telephone Number : 760-922-4981
Fax Number : 760-922-4442
Authorized Official
Title or Position : CEO
Name : YVONNE BELL
Credential : MBA
Telephone Number : 760-344-9951
Provider Enumeration Date : 10/06/2006
Last Update Date : 03/07/2024

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