Provider Demographics
NPI:1013220052
Name:MOUNTAIN OAK HEALTH CENTERS
Entity Type:Organization
Organization Name:MOUNTAIN OAK HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ ORNUM
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:209-890-8660
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-0536
Mailing Address - Country:US
Mailing Address - Phone:209-498-2014
Mailing Address - Fax:
Practice Address - Street 1:556 MOUNTAIN RANCH ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-0536
Practice Address - Country:US
Practice Address - Phone:209-498-2014
Practice Address - Fax:209-498-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health