NPIMap

Organization Active NPI

United Health Centers of the San Joaquin Valley

  • Federally Qualified Health Center (FQHC)
  • Fowler, CA
National Provider Identifier
1902475833
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Practice address
130 S 6TH St
Fowler, CA 93625-2438
Phone
(559) 646-6618
NPI assigned
Jun 24, 2021
Last updated
Apr 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Lou Lopez
Title
Director of Billing
Phone
(800) 492-4227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

130 S 6TH St
Fowler, CA 93625-2438

Mailing address

3875 W Beechwood Ave
Fresno, CA 93711-0795
Phone (559) 646-6618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240307001365 CA Part A Provider - Federally Qualified Health Center (FQHC) 5991727802 Practice locations: Fowler, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902475833. Details of each certification follow.

Federally qualified health center certification: CCN A01843

Legal name
UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 16, 2024
Last certification
Feb 16, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1971 in CA
Enrollment address
130 S 6TH St
Fowler, CA 93625-2438

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2299470United Health Centers of the San Joaquin Valley130 6TH St, Fowler, CA 93625Certificate of waiverFeb 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
Robert Wageneck DO91 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mary Lou Lopez Individual W-2 Managing EmployeeDirector of Billing Sep 17, 1997
Gregory Williams Individual Corporate OfficerCmo Jan 4, 2021
Esther Nicacio Individual Corporate DirectorBoard Member May 27, 2010
Jesus Rafael Maldonado Hernandez Individual Corporate OfficerCFP & VP Nov 2, 2015
Maricela Vargas Individual Corporate DirectorBoard Member Apr 1, 2022
Michael Graville Individual Corporate DirectorBoard Member Jan 1, 2023
Ofelia Garcia Individual Corporate DirectorBoard Member Mar 31, 2011
Sarah Guerra Individual Corporate DirectorBoard Member Jan 1, 2018
Edna L Avalos Individual Corporate DirectorBoard Member Jan 1, 2018
Nathan Williams Individual Corporate DirectorBoard Member Sep 1, 2018
John Shantz Individual Corporate DirectorBoard Member Apr 1, 2015
Jose Gutierrez Individual Corporate DirectorBoard Member Aug 1, 2020
Nicole Thompson Individual Corporate DirectorBoard Member Nov 1, 2020
Justin W Preas Individual Corporate OfficerPresident & Ceo Apr 25, 2005

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
United Health Centers of the San Joaquin ValleyCorcoran, CA, CCN 751010 Federally qualified health center Operational/Managerial Control (100%) Feb 21, 2012
United Health Centers of the San Joaquin ValleyReedley, CA, CCN 751086 Federally qualified health center Operational/Managerial Control Jun 23, 2014
United Health Centers of the San Joaquin ValleyFresno, CA, CCN 751895 Federally qualified health center Operational/Managerial Control Apr 10, 2023
United Health Centers of the San Joaquin ValleyFresno, CA, CCN 751930 Federally qualified health center Operational/Managerial Control Dec 8, 2015
United Health Centers of the San Joaquin ValleySanger, CA, CCN 921076 Federally qualified health center Operational/Managerial Control Feb 28, 2018
United Health Centers of the San Joaquin ValleyLemoore, CA, CCN 921073 Federally qualified health center Operational/Managerial Control Apr 19, 2018
United Health Centers of the San Joaquin ValleyFowler, CA, CCN A01933 Federally qualified health center Operational/Managerial Control (100%) Sep 15, 2016

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1902475833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3875 W BEECHWOOD AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937110795",
            "telephone_number": "559-646-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S 6TH ST",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936252438",
            "telephone_number": "559-646-6618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "MARY LOU",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "800-492-4227"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fowler, CA

Sources for this page

Verify at the official NPI Registry.