Healthcare Provider Details

I. General information

NPI: 1023068798
Provider Name (Legal Business Name): VALLEY NUCLEAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE
FRESNO CA
93720-3309
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 559-449-3109
  • Fax:
Mailing address:
  • Phone: 415-884-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK BERNARD
Title or Position: PRESIDENT
Credential: MD
Phone: 559-449-3109