Basic Information
| Provider Information | |||||||||
| NPI: | 1407188675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDEN VALLEY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W CHILDS AVE RM 8 | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093837441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 TENAYA DR | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953543930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095766766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2010 | ||||||||
| LastUpdateDate: | 02/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | TRINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT FOR CREDEN | ||||||||
| AuthorizedOfficialTelephone: | 2093855240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 24876 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.