1407114465 NPI number — VALLEY CENTER FOR PAIN MEDICINE AND REGIONAL ANESTHESIA CORP

Table of content: MS. ANN M. KELLY C.A.S.A.C. (NPI 1073733564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407114465 NPI number — VALLEY CENTER FOR PAIN MEDICINE AND REGIONAL ANESTHESIA CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CENTER FOR PAIN MEDICINE AND REGIONAL ANESTHESIA CORP
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:
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:
1407114465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95344-0123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-381-0127
Provider Business Mailing Address Fax Number:
209-381-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3321 M ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-381-0127
Provider Business Practice Location Address Fax Number:
209-381-0130
Provider Enumeration Date:
04/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DUONG
Authorized Official First Name:
HAI
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-761-6358

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  A103786 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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