Basic Information
Provider Information
NPI: 1003253048
EntityType: 2
ReplacementNPI:  
OrganizationName: VIRGINIA GARCIA MEMORIAL HEALTH CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: PO BOX 6149
Address2:  
City: ALOHA
State: OR
PostalCode: 970070149
CountryCode: US
TelephoneNumber: 5036405297
FaxNumber: 5036405780
Practice Location
Address1: 971 SW WALNUT ST
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971235651
CountryCode: US
TelephoneNumber: 5036405297
FaxNumber: 5036405780
Other Information
ProviderEnumerationDate: 05/31/2013
LastUpdateDate: 01/10/2018
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LOREDO
AuthorizedOfficialFirstName: MARIA
AuthorizedOfficialMiddleName: E
AuthorizedOfficialTitleorPosition: COO
AuthorizedOfficialTelephone: 5033598502
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QF0400X  Y Ambulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)

No ID Information.


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