Basic Information
| Provider Information | |||||||||
| NPI: | 1902025059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL VALLEY INDIAN HEALTH INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL VALLEY INDIAN HEALTH CLINIC PRATHER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 HERNDON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592992578 | ||||||||
| FaxNumber: | 5592991421 | ||||||||
| Practice Location | |||||||||
| Address1: | 29369 AUBERRY RD | ||||||||
| Address2: | 102 | ||||||||
| City: | PRATHER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936519784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598555390 | ||||||||
| FaxNumber: | 5592991421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | FOWLER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5592992578 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 040000392 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.