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NPI Code Detail

MEDICARE: LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC

MEDICARE: LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER 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)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417372731
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Provider Business Mailing Address
First Line : 931 CHEVY WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4127
Country : US
Telephone Number : 541-535-6239
Fax Number : 541-842-2212
Provider Business Practice Location Address
First Line : 910 S CENTRAL AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97501-7822
Country : US
Telephone Number : 541-618-1380
Fax Number : 541-618-1385
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : TARA LYNETTE JEANNOT
Credential :
Telephone Number : 541-535-6239
Provider Enumeration Date : 02/24/2014
Last Update Date : 07/15/2019

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