Basic Information
| Provider Information | |||||||||
| NPI: | 1689048241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICA DE SALUD DEL VALLE DE SALINAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 AIRPROT BLVD | ||||||||
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| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93905 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 FIFTH STREET | ||||||||
| Address2: | |||||||||
| City: | GONZALEZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317578689 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2015 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | CUEVAS | ||||||||
| AuthorizedOfficialFirstName: | MAXIMILLIANO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/MD | ||||||||
| AuthorizedOfficialTelephone: | 8317578689 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLINICA DE SALUD DEL VALLE DE SALINAS | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.