| |
1601 E Fourth Plain Blvd Bldg 17 Vancouver WA 98661-3717 | |
(360) 558-5795 | |
(360) 397-8494 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1601 E Fourth Plain Blvd Bldg 17, Vancouver, Washington |
Authorized Official Name and Position | Rogelio Riojas (CEO) |
Authorized Official Contact | 2067635277 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 34703 Seattle WA 98124-1703 Ph: () - | 1601 E Fourth Plain Blvd Bldg 17 Vancouver WA 98661-3717 Ph: (360) 558-5795 |
NPI Number | 1669038543 |
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Provider Enumeration Date | 05/15/2019 |
Last Update Date | 01/31/2025 |
Identifier | Type | State | Issuer |
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1669038543 | NPI | - | NPPES |
2135934 | Medicaid | WA |
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