Lake County Tribal Health Southshore Clinic
NPI #1063158038 in Clearlake, California
Provider Information
- NPI Number
- 1063158038
- Entity Type
- Organization
- Organization Name
- Lake County Tribal Health Southshore Clinic
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.
- Primary Specialty
- Clinic/Center - Federally Qualified Health Center (FQHC)
- Enumeration Date
- May 11, 2022
- Last Updated
- Apr 2, 2024
Practice Location
- Address
- 14440 OLYMPIC DRIVE
- City
- Clearlake
- State
- California
- ZIP Code
- 95422
- Phone
- (707) 263-8382
Authorized Official
- Name
- MR. ERNESTO PADILLA
- Title
- CEO
- Phone
- (707) 263-8382
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
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