Healthcare Provider Details

I. General information

NPI: 1154873230
Provider Name (Legal Business Name): VALLEY WOMEN'S HEALTHCARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5293 N 1ST ST
FRESNO CA
93710-7007
US

IV. Provider business mailing address

PO BOX 27890
FRESNO CA
93729-7890
US

V. Phone/Fax

Practice location:
  • Phone: 559-244-0133
  • Fax: 559-477-4584
Mailing address:
  • Phone: 559-244-0133
  • Fax: 559-477-4584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEANNA FRIEDLINE
Title or Position: BILLING DIRECTOR
Credential:
Phone: 559-860-0822