Healthcare Provider Details

I. General information

NPI: 1942294327
Provider Name (Legal Business Name): CENTRAL VALLEY URGENT CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 W SHIELDS AVE
FRESNO CA
93705-4102
US

IV. Provider business mailing address

199 W SHIELDS AVE
FRESNO CA
93705-4102
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-4706
  • Fax: 559-225-4710
Mailing address:
  • Phone: 559-225-4706
  • Fax: 559-225-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GILBERT DANIEL BUSTOS
Title or Position: MANAGER
Credential: AO
Phone: 559-225-4706