Provider Demographics
NPI:1932280633
Name:CLINICAS DE SALUD DEL PUEBLO INC
Entity Type:Organization
Organization Name:CLINICAS DE SALUD DEL PUEBLO INC
Other - Org Name:INNERCARE - MECCA
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 1:91275 66TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254
Practice Address - Country:US
Practice Address - Phone:760-396-0521
Practice Address - Fax:760-396-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000089261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70659FMedicaid
551836Medicare Oscar/Certification