Healthcare Provider Details

I. General information

NPI: 1497669279
Provider Name (Legal Business Name): CENTRAL VALLEY ADVANCED SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 N MILBURN AVE STE 105
FRESNO CA
93722-8450
US

IV. Provider business mailing address

7206 N MILBURN AVE STE 105
FRESNO CA
93722-8450
US

V. Phone/Fax

Practice location:
  • Phone: 559-758-7119
  • Fax:
Mailing address:
  • Phone: 559-758-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DEVAN ORD HIGGINBOTHAM
Title or Position: DIRECTOR
Credential: MD
Phone: 559-907-0930