Provider Demographics
NPI:1417939968
Name:UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Entity Type:Organization
Organization Name:UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-646-6618
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648
Mailing Address - Country:US
Mailing Address - Phone:559-646-3561
Mailing Address - Fax:559-646-6915
Practice Address - Street 1:476 E WASHINGTON
Practice Address - Street 2:
Practice Address - City:EARLIMART
Practice Address - State:CA
Practice Address - Zip Code:93219
Practice Address - Country:US
Practice Address - Phone:661-849-2781
Practice Address - Fax:661-849-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA351OtherHEALTH NET MEDI-CAL
CA341OtherBLUE CROSS MEDI-CAL
CAFHC03861FMedicaid