1740682319 NPI number — CENTRAL VALLEY PALLIATIVE MEDICINE 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 1740682319 NPI number — CENTRAL VALLEY PALLIATIVE MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL VALLEY PALLIATIVE MEDICINE 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:
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:
1740682319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 W HERNDON AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93612-0381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-570-0070
Provider Business Mailing Address Fax Number:
559-570-0059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7145 N CHESTNUT AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-0359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-284-7264
Provider Business Practice Location Address Fax Number:
559-326-2170
Provider Enumeration Date:
09/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COPELAND
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-284-7264

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X , with the licence number:  20A10829 , 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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