1346539483 NPI number — VALLEY MEDICAL GROUP OF KERN COUNTY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346539483 NPI number — VALLEY MEDICAL GROUP OF KERN COUNTY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY MEDICAL GROUP OF KERN COUNTY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346539483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAFTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93263-0640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-391-4530
Provider Business Mailing Address Fax Number:
661-391-4536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 AVIATION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAFTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93263-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-391-4530
Provider Business Practice Location Address Fax Number:
661-391-4536
Provider Enumeration Date:
03/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CABEZZAS
Authorized Official First Name:
NOEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT/COO
Authorized Official Telephone Number:
661-496-9300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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