Provider Demographics
NPI:1528108610
Name:ALTA FAMILY HEALTH CLINIC, INC.
Entity type:Organization
Organization Name:ALTA FAMILY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KULDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:THUSU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-595-1000
Mailing Address - Street 1:888 N ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-3089
Mailing Address - Country:US
Mailing Address - Phone:559-595-1000
Mailing Address - Fax:559-595-1862
Practice Address - Street 1:888 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3089
Practice Address - Country:US
Practice Address - Phone:559-595-1000
Practice Address - Fax:559-595-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000633261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051978Medicare Oscar/Certification