Healthcare Provider Details

I. General information

NPI: 1710085014
Provider Name (Legal Business Name): SAN JOAQUIN VALLEY INTERVENTIONAL PAIN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 N 1ST ST
FRESNO CA
93710-5447
US

IV. Provider business mailing address

PO BOX 3969
CERRITOS CA
90703-3969
US

V. Phone/Fax

Practice location:
  • Phone: 562-407-2080
  • Fax: 562-407-2082
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN FRANCIS PETRAGLIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-407-2080