Provider Demographics
NPI:1225448020
Name:TULARE WALK-IN FAMILY CLINIC INC
Entity Type:Organization
Organization Name:TULARE WALK-IN FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAYARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-685-9808
Mailing Address - Street 1:975 E MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2221
Mailing Address - Country:US
Mailing Address - Phone:559-685-9808
Mailing Address - Fax:559-685-1071
Practice Address - Street 1:975 E MERRITT AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2221
Practice Address - Country:US
Practice Address - Phone:559-685-9808
Practice Address - Fax:559-685-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A916840Medicare PIN