MEDICARE: VALLEY HEALTH TEAM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	100077AN	CA
2	106H00000X	Marriage & Family Therapist		CA
3	122300000X	Dentist		CA
4	122300000X	Dentist		CA
5	152W00000X	Optometrist		CA
6	207Q00000X	Family Medicine Physician		CA
7	208000000X	Pediatrics Physician		CA
8	208000000X	Pediatrics Physician		CA
9	2085B0100X	Body Imaging Physician		CA
10	2085B0100X	Body Imaging Physician		CA
11	363A00000X	Physician Assistant		CA
12	363A00000X	Physician Assistant		CA
13	207Q00000X	Family Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215093745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEALTH TEAM, INC.

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:	21890 COLORADO AVE
City	:	SAN JOAQUIN
State	:	CA
Zip	:	93660-0000
Country	:	US
Telephone Number	:	559-693-2462
Fax Number	:	559-693-4382

Provider Business Practice Location Address
First Line	:	21890 COLORADO
Second Line	:
City	:	SAN JOAQUIN
State	:	CA
Zip	:	93660-0000
Country	:	US
Telephone Number	:	559-693-2462
Fax Number	:	559-693-4382

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. SOYLA R. GRIFFIN
Credential	:	C.P.A
Telephone Number	:	559-693-2462

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	03/14/2008

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