|
| |
|
655 S. Central Valley Hwy Shafter CA 93263-2790 | |
| (866) 707-6664 | |
| (661) 746-9197 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 655 S. Central Valley Hwy, Shafter, California |
| Authorized Official Name and Position | Francisco L Castillon (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6616307050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4900 California Ave 400b Bakersfield CA 93309-7081 Ph: (661) 459-1900 | 655 S. Central Valley Hwy Shafter CA 93263-2790 Ph: (866) 707-6664 |
| NPI Number | 1366463085 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 09/24/2024 |
| Medicare PECOS PAC ID | 9234176363 |
|---|---|
| Medicare Enrollment ID | O20050512000311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366463085 | NPI | - | NPPES |
| FHC70965F | Medicaid | CA | |
| HAP70965F | Other | CA | DHCS/FAMILY PACT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 120000652 (California) | Primary |
| Provider Name | Norbert Gal |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1225197627 PECOS PAC ID: 1658373055 Enrollment ID: I20070214000295 |
| Provider Name | Debra Metter |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649371055 PECOS PAC ID: 4486891447 Enrollment ID: I20130510000245 |
Olivia Park Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1110 E Lerdo Hwy Ste 200, Shafter, CA 93263 Phone: 661-746-6989 | |
Ruby Dacio Dds Andlutgarda Perez Dds Dental Corp Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 James St, Shafter, CA 93263 Phone: 661-746-4067 |