Basic Information
| Provider Information | |||||||||
| NPI: | 1598991481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAKIMA VALLEY FARM WORKER CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 W 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989481564 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 518 W 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989481564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098656901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 06/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | SIFUENTES | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED PRACTICAL NURSE | ||||||||
| AuthorizedOfficialTelephone: | 5098656901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | LP00034464 | WA | Y | Agencies | Case Management |
No ID Information.