Provider Demographics
NPI:1124321583
Name:CENTRAL VALLEY INDIAN HEALTH, INC.
Entity type:Organization
Organization Name:CENTRAL VALLEY INDIAN HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NILZA
Authorized Official - Middle Name:MELLO
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-299-4264
Mailing Address - Street 1:20 N DEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0311
Mailing Address - Country:US
Mailing Address - Phone:559-299-4264
Mailing Address - Fax:559-299-1421
Practice Address - Street 1:20 N DEWITT AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0311
Practice Address - Country:US
Practice Address - Phone:559-299-4264
Practice Address - Fax:559-299-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7366261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center