LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC. NPI 1104194133

NPI Information

LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC. is a federally qualified health center (fqhc) clinic center in Medford, OR. LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC. NPI is 1104194133. The provider is registered as an organization entity type.
The provider Is Doing Business As Mobile Health Center- La Clinica.

The provider's business location address is:

3617 S PACIFIC HWY
MEDFORD, OR
ZIP 97501
Phone: (541) 535-6239
Fax: (541) 512-1026

The provider's authorized official is Tara Lynette Jeannot .
The authorized official title is Chief Operations Officer and has the following contact phone number (541) 535-6239.

The CLIA number assigned to this NPI record is 38D2154064 - mobile laboratory with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/5/2011 and was last updated on 7/15/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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