Organization
AMPLA HEALTH
Active
Other names
AMPLA HEALTH COLUSA MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN H FLORES MPH (PRESIDENT, CHIEF EXECUTIVE OFFICER)
(530) 751-3778
Entity
Organization
Contact information
Practice address
555 FREMONT ST, COLUSA, CA 95932-2534
(530) 458-8635
(530) 458-7830
Mailing address
PO BOX AD, YUBA CITY, CA 95992-1396
(530) 751-3778
(530) 751-1237
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261Q00000X
Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
230000216
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6865328
—
CA
01
—
BCP70544F
EWC:CDP:BCEDP
CA
01
—
HAP70544F
FAMILY PLANNING
CA
Enumeration date
07/09/2006
Last updated
02/29/2024
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