Provider Demographics
NPI:1952326811
Name:AMPLA HEALTH
Entity Type:Organization
Organization Name:AMPLA HEALTH
Other - Org Name:AMPLA HEALTH YUBA CITY PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, CHIEF EXECUTIVE OFFICER
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:MPH
Authorized Official - Phone:530-751-3778
Mailing Address - Street 1:PO BOX AD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-1396
Mailing Address - Country:US
Mailing Address - Phone:530-751-3778
Mailing Address - Fax:530-751-1237
Practice Address - Street 1:931 MARKET ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4210
Practice Address - Country:US
Practice Address - Phone:530-671-8820
Practice Address - Fax:530-671-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA230000337261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1948734Medicaid
CAFHC70940FMedicaid