Provider Demographics
NPI:1699859421
Name:CLINICAS DE SALUD DEL PUEBLO
Entity Type:Organization
Organization Name:CLINICAS DE SALUD DEL PUEBLO
Other - Org Name:BRAWLEY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:760-344-9951
Mailing Address - Street 1:852 E DANENBERG DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-344-9951
Mailing Address - Fax:760-344-5840
Practice Address - Street 1:1166 K ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2737
Practice Address - Country:US
Practice Address - Phone:760-344-3583
Practice Address - Fax:760-344-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000670261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA090000670OtherDHS LICENSE
CAFHC70977FMedicaid