Basic Information
| Provider Information | |||||||||
| NPI: | 1588601041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICA DE SALUD DEL VALLE DE SALINAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 PLAZA CIR | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939012952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317578689 | ||||||||
| FaxNumber: | 8317576480 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 N SANBORN RD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939052218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317571365 | ||||||||
| FaxNumber: | 8317572824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | CUEVAS | ||||||||
| AuthorizedOfficialFirstName: | MAXIMILIANO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8317578689 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 70000264 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QF0400X | 70000277 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QF0400X | 70000335 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC70610F | 05 | CA | MEDICAID | FHC03913F | 05 | CA | MEDICAID | FHC70516F | 05 | CA | MEDICAID | FHC70090F | 05 | CA | MEDICAID | FHC70484F | 05 | CA | MEDICAID | FHC70799F | 05 | CA | MEDICAID |