Basic Information
| Provider Information | |||||||||
| NPI: | 1497961882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790 | ||||||||
| Address2: | |||||||||
| City: | PARLIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936480790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596463561 | ||||||||
| FaxNumber: | 5596463642 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 S ZEDIKER AVE | ||||||||
| Address2: | |||||||||
| City: | PARLIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936482639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596463561 | ||||||||
| FaxNumber: | 5596463642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5596466618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | ZZZ77653Z | 01 | CA | BLUE SHIELD OF CA | OTHER |