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1945 N Fine Ave Ste 100 Fresno CA 93727-1528 | |
| (559) 457-5650 | |
| (559) 457-5695 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1945 N Fine Ave Ste 100, Fresno, California |
| Authorized Official Name and Position | Olga Meave (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6616353050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1559 Bakersfield CA 93302-1559 Ph: (661) 635-3050 | 1945 N Fine Ave Ste 100 Fresno CA 93727-1528 Ph: (559) 457-5650 |
| NPI Number | 1720347149 |
|---|---|
| Provider Enumeration Date | 05/04/2012 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/09/2024 |
| Medicare PECOS PAC ID | 3870407505 |
|---|---|
| Medicare Enrollment ID | O20140116001085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720347149 | NPI | - | NPPES |
| 550002258 | Other | CA | STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (California) | Primary |
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