Organization
GOLDEN VALLEY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY WEBER (CEO)
(209) 384-6493
Entity
Organization
Contact information
Practice address
725 W I ST, LOS BANOS, CA 93635-3478
(209) 826-1094
(209) 826-7808
Mailing address
737 W CHILDS AVE, MERCED, CA 95341-6805
(209) 384-6493
(209) 383-1296
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
040000553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040000553
STATE OF CA LIC#
CA
05
—
CMM71062F
—
CA
Enumeration date
12/02/2005
Last updated
02/09/2017
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