Basic Information
| Provider Information | |||||||||
| NPI: | 1508064981 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL CA WOMEN'S FACILITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9723 MAXINE ST | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906605308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629491440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23370 ROAD 22 | ||||||||
| Address2: | |||||||||
| City: | CHOWCHILLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936101501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596655531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | IYER | ||||||||
| AuthorizedOfficialFirstName: | KUMARI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 5596655531 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2400X | 403433 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
No ID Information.