Provider Demographics
NPI:1467792176
Name:NEIGHBORHOOD WALK IN CLINIC
Entity Type:Organization
Organization Name:NEIGHBORHOOD WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGANGA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-458-0207
Mailing Address - Street 1:4182 N 1ST ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4300
Mailing Address - Country:US
Mailing Address - Phone:559-224-3300
Mailing Address - Fax:559-224-3306
Practice Address - Street 1:4182 N 1ST ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4300
Practice Address - Country:US
Practice Address - Phone:559-224-3300
Practice Address - Fax:559-224-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHC541AMedicare Oscar/Certification