Provider Demographics
NPI:1487965760
Name:SALIDA DEL SOL FAMILY HEALTH MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:SALIDA DEL SOL FAMILY HEALTH MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BA
Authorized Official - Middle Name:X
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-487-9892
Mailing Address - Street 1:815 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5445
Mailing Address - Country:US
Mailing Address - Phone:805-487-9892
Mailing Address - Fax:805-487-7560
Practice Address - Street 1:815 COOPER RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5445
Practice Address - Country:US
Practice Address - Phone:805-487-9892
Practice Address - Fax:805-487-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31757261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center