Provider Demographics
NPI:1255540092
Name:UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Entity type:Organization
Organization Name:UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-646-6618
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-0790
Mailing Address - Country:US
Mailing Address - Phone:559-646-3561
Mailing Address - Fax:559-646-3642
Practice Address - Street 1:121 BARBOZA ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-1901
Practice Address - Country:US
Practice Address - Phone:559-655-5000
Practice Address - Fax:559-655-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000313261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427269521Medicaid
CA1427269521Medicaid