Provider Demographics
NPI:1790105559
Name:ALTURA CENTERS FOR HEALTH
Entity Type:Organization
Organization Name:ALTURA CENTERS FOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-685-4601
Mailing Address - Street 1:1201 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:559-366-7060
Practice Address - Street 1:600 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2978
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-366-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790105559Medicaid
CAFHC53895FMedicaid