Provider Demographics
NPI:1104955483
Name:COALINGA VALLEY HEALTH CLINICS. INC
Entity type:Organization
Organization Name:COALINGA VALLEY HEALTH CLINICS. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:APODACA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:559-935-4374
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-0495
Mailing Address - Country:US
Mailing Address - Phone:559-935-4374
Mailing Address - Fax:559-935-4316
Practice Address - Street 1:36617 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234-1628
Practice Address - Country:US
Practice Address - Phone:559-945-9251
Practice Address - Fax:559-945-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66374305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA553927Medicare Oscar/Certification