Basic Information
| Provider Information | |||||||||
| NPI: | 1457974206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3875 W BEECHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937110795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004924227 | ||||||||
| FaxNumber: | 8446691640 | ||||||||
| Practice Location | |||||||||
| Address1: | 2630 TUOLUMNE ST BLDG A | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004924227 | ||||||||
| FaxNumber: | 8446691640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2020 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | MARY LOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CENTRAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5596466618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.