MEDICARE: VALLEY HEALTH TEAM, 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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number	:	1598821027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEALTH TEAM, INC.

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:
City	:	SAN JOAQUIN
State	:	CA
Zip	:	93660-0737
Country	:	US
Telephone Number	:	559-693-2462
Fax Number	:	559-693-4382

Provider Business Practice Location Address
First Line	:	21890 COLORADO AVE
Second Line	:
City	:	SAN JOAQUIN
State	:	CA
Zip	:	93660-0737
Country	:	US
Telephone Number	:	559-693-2462
Fax Number	:	559-693-2398

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. SOYLA R. GRIFFIN
Credential	:	C.P.A
Telephone Number	:	559-693-2462

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/27/2019

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