Clinica de Salud del Valle de Salinas
Organization Active NPI Federally Qualified Health Center (FQHC) · Soledad, CA
NPI 1053452136 · NPPES record last updated Jun 6, 2024
Key facts
- NPI
- 1053452136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 070000277 (CA)
- Legal business name
- CLINICA DE SALUD DEL VALLE DE SALINAS
- Practice address
- 799 Front St
Soledad, CA 93960-3017 - Phone
- (831) 678-0881
- Fax
- (831) 678-2803
- NPI assigned
- Feb 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Maximiliano Cuevas, M.D.
- Title
- Ceo
- Phone
- (831) 757-8689
Owners & managing parties with NPI records 1
-
Maximiliano Cuevas, M.D.
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 8
Practitioners 36
-
Bassam Taha Al-Rawi, DMD, MS
-
Terrence C Hack, M.D., FACC
-
Farnaz Haroon, D.D.S.
-
Maria Magana, OD
-
Oguchi Nkwocha, MD
-
Bob Peng, MD
-
Donald C Pompan, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0937914 | Clinica de Salud del Valle de Salinas | Provider-performed microscopy | Dec 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051953
- Legal name
- CLINICA DE SALUD DEL VALLE DE SALINAS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 1, 1995
- Last certification
- Jul 1, 1995
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 9, 1980 in CA
- Enrollment address
- 799 Front St
Soledad, CA 93960-3017
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Maximiliano Cuevas |
Corporate Director |
Jan 1, 2015 | |
| Michael Victor |
W-2 Managing Employee | Jan 14, 2019 | |
| Ruben Jimenez |
W-2 Managing Employee | Sep 5, 2018 | |
| Jesus Lopez |
Corporate Director | Apr 5, 2012 | |
| Maria Villagomez |
Operational/Managerial Control | Oct 1, 2015 | |
| Rogelio Jacinto |
Corporate Director | Mar 2, 1998 | |
| Raymond Gonzalez |
Corporate Director | Mar 1, 2001 | |
| Maria Aguilar |
Corporate Director | Jun 5, 2008 | |
| Genaro Carlos |
Corporate Director | Mar 2, 1998 | |
| Victoria Coley |
Corporate Director | Feb 7, 2019 | |
| Ali Chavez |
Corporate Director | Mar 2, 1998 | |
| Elizabeth Reyes |
Corporate Director | Nov 15, 1999 | |
| Aurelio Gonzalez |
Corporate Director | Oct 7, 2010 | |
| Silvana Fiege |
W-2 Managing Employee | Jan 12, 2009 | |
| Josefina Rodriguez |
Corporate Director | Nov 15, 1999 | |
| Criselia Serrano |
Corporate Director | Mar 2, 1998 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| CSVS - Plaza Circle |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081118000667 | CA | Part B Supplier - Clinic/Group Practice | 3678513736 |
Receives reassigned benefits from 71 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Castroville, CA; Gonzales, CA; Greenfield, CA; King City, CA; Royal Oaks, CA; Salinas, CA; Soledad, CA |
| O20100623001009 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 3678513736 | Practice locations: Soledad, CA |
National Provider Directory
- Tax ID family
- Rafael O Siqueiros MD
Locations
440 Airport Blvd
Salinas, CA 93905
Phone (831) 757-0434
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 070000277 | CA | Yes |
Addresses
Primary practice location
799 Front St
Soledad, CA 93960-3017
Mailing address
55 Plaza Cir Ste a
Salinas, CA 93901-2952
Phone (831) 757-8689
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC03913F | Medicaid | CA |
Other providers in Soledad, CA
- Alyzah Castro
- Robert E. Cater II
- Alison Guadalupe Cervantes
- Anuradha C Challa
- Joseph Claybaugh
- Maria Colima-Jimenez
- Anthony Noel Contreras-Zamora
- David Cordero
- Benjamin Frank Cornelsen
- Odalis Adriana Coronado
All providers in Soledad, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.