Healthcare Provider Details

I. General information

NPI: 1477920197
Provider Name (Legal Business Name): VALLEY CHILDREN'S PRIMARY CARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD RIVER RD SUITE 125
BAKERSFIELD CA
93311-9503
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-3122
  • Fax: 661-663-3133
Mailing address:
  • Phone: 559-353-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHRISTENSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-353-3000