Organization
UP-VALLEY MEDI-CAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA GONZALES (ADMINISTRATIVE ASSISTANT)
(707) 967-2810
Entity
Organization
Contact information
Practice address
465 MAIN ST, SAINT HELENA, CA 94574-2159
(707) 967-2810
Mailing address
465 MAIN ST, SAINT HELENA, CA 94574-2159
(707) 967-2810
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SS2866290
—
CA
Enumeration date
04/13/2007
Last updated
08/22/2020
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