NORTHEAST VALLEY HEALTH CORPORATION NPI 1114928595

NPI Information

NORTHEAST VALLEY HEALTH CORPORATION is a federally qualified health center (fqhc) clinic center in Pacoima, CA. NORTHEAST VALLEY HEALTH CORPORATION NPI is 1114928595. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pacoima Health Center.

The provider's business location address is:

12756 VAN NUYS BLVD
PACOIMA, CA
ZIP 91331-626
Phone: (818) 896-0531
Fax: (818) 896-5850

The provider's authorized official is Kimberly Wyard .
The authorized official title is Chief Executive Officer and has the following contact phone number (818) 898-1388.

The CLIA number assigned to this NPI record is 05D0666584 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/9/2005 and was last updated on 2/22/2022.

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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