Basic Information
| Provider Information | |||||||||
| NPI: | 1295810174 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN BENITO HEALTH FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 FELICE DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950233361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316375306 | ||||||||
| FaxNumber: | 8316379640 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 FELICE DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950233361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316375306 | ||||||||
| FaxNumber: | 8316379640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | ROSA | ||||||||
| AuthorizedOfficialMiddleName: | VIVIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8316375306 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | HAP03872F | 05 | CA | MEDICAID | EAP03872F | 01 | CA | UNCOMPENSATED CARE | OTHER | BCP03872F | 05 | CA | MEDICAID | FHC03872F | 01 | CA | MEDI-CAL IDENTIFIER | OTHER |