Basic Information
| Provider Information | |||||||||
| NPI: | 1124321583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL VALLEY INDIAN HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 N DEWITT AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936120311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592994264 | ||||||||
| FaxNumber: | 5592991421 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 N DEWITT AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936120311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592994264 | ||||||||
| FaxNumber: | 5592991421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2010 | ||||||||
| LastUpdateDate: | 12/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | REICH | ||||||||
| AuthorizedOfficialFirstName: | NILZA | ||||||||
| AuthorizedOfficialMiddleName: | MELLO | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5592994264 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 20A7366 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.