Provider Demographics
NPI:1225252869
Name:FIREBAUGH AND MENDOTA HEALTH CLINICS, INC.
Entity Type:Organization
Organization Name:FIREBAUGH AND MENDOTA HEALTH CLINICS, INC.
Other - Org Name:MENDOTA FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ISELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-449-1237
Mailing Address - Street 1:2057 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3512
Mailing Address - Country:US
Mailing Address - Phone:559-897-5399
Mailing Address - Fax:559-897-9670
Practice Address - Street 1:507 OLLER ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-2360
Practice Address - Country:US
Practice Address - Phone:559-655-4211
Practice Address - Fax:559-655-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03914HMedicaid
CARHM03914HMedicaid
CA053914Medicare Oscar/Certification