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21890 Colorado Ave San Joaquin CA 93660-0737 | |
(559) 693-2462 | |
(559) 693-2398 |
Full Name | |
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Speciality | Clinic/Center |
Location | 21890 Colorado Ave, San Joaquin, California |
Authorized Official Name and Position | Soyla R. Griffin (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5596932462 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 737 San Joaquin CA 93660-0737 Ph: (559) 693-2462 | 21890 Colorado Ave San Joaquin CA 93660-0737 Ph: (559) 693-2462 |
NPI Number | 1598821027 |
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Provider Enumeration Date | 12/29/2006 |
Last Update Date | 07/27/2019 |
Medicare PECOS PAC ID | 2365588902 |
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Medicare Enrollment ID | O20091012000448 |
Identifier | Type | State | Issuer |
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1598821027 | NPI | - | NPPES |
FHC03875F | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |