Healthcare Provider Details

I. General information

NPI: 1033146998
Provider Name (Legal Business Name): CENTRAL VALLEY OCCUPATIONAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 TRUXTUN AVE STE 200
BAKERSFIELD CA
93309-0656
US

IV. Provider business mailing address

4100 TRUXTUN AVE STE 200
BAKERSFIELD CA
93309-0656
US

V. Phone/Fax

Practice location:
  • Phone: 661-632-1540
  • Fax: 661-632-1538
Mailing address:
  • Phone: 661-632-1540
  • Fax: 661-632-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA31892
License Number StateCA

VIII. Authorized Official

Name: MRS. ALEJANDRA BENAVIDES
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 661-632-1540