Basic Information
| Provider Information | |||||||||
| NPI: | 1669513453 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICA DE SALUD DEL VALLE DE SALINAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939053302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317578689 | ||||||||
| FaxNumber: | 8317573721 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 BASSETT ST | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939302942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313855945 | ||||||||
| FaxNumber: | 8313850767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CUEVAS | ||||||||
| AuthorizedOfficialFirstName: | MAXIMILIANO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8317578689 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | FHC70799F | 05 | CA | MEDICAID |