Provider Demographics
NPI:1629861182
Name:LA CLINICA DEL VALLE FAMILY HEALTHCARE CENTER INC.
Entity type:Organization
Organization Name:LA CLINICA DEL VALLE FAMILY HEALTHCARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOCHIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-512-3127
Mailing Address - Street 1:931 CHEVY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4127
Mailing Address - Country:US
Mailing Address - Phone:541-535-6239
Mailing Address - Fax:
Practice Address - Street 1:225 OAK ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9567
Practice Address - Country:US
Practice Address - Phone:541-507-8550
Practice Address - Fax:541-494-1789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA CLINICA DEL VALLE FAMILY HEALTHCARE CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)