Basic Information
| Provider Information | |||||||||
| NPI: | 1477979722 | ||||||||
| 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: | ATTN MANAGED CARE | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596466618 | ||||||||
| FaxNumber: | 5598766705 | ||||||||
| Practice Location | |||||||||
| Address1: | 429 E MANNING AVE | ||||||||
| Address2: | |||||||||
| City: | PARLIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936482668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599242015 | ||||||||
| FaxNumber: | 5599250568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2014 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | CURTIS | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5596466618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 550002830 | 01 | CA | STATE OF CA DEPARTMENT OF PUBLIC HEALTH | OTHER | 1477979722 | 05 | CA | MEDICAID |