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2101 7th Street Wasco CA 93280-1502 | |
| (866) 707-6664 | |
| (661) 746-9197 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2101 7th Street, Wasco, 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 | 2101 7th Street Wasco CA 93280-1502 Ph: (866) 707-6664 |
| NPI Number | 1689688004 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 09/24/2024 |
| Medicare PECOS PAC ID | 9234176363 |
|---|---|
| Medicare Enrollment ID | O20100628000789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689688004 | NPI | - | NPPES |
| BCP80030F | Other | CA | CDHS |
| FHC80030F | Medicaid | CA | |
| HAP80030F | Other | CA | DHCS/FAMILY PACT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 120000254 (California) | Primary |
Dr D S Park Dental Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1245 7th St, Wasco, CA 93280 Phone: 661-758-3021 Fax: 661-758-6780 | |