Healthcare Provider Details

I. General information

NPI: 1003992710
Provider Name (Legal Business Name): CENTRAL VALLEY PEDIATRICS , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 N HOWARD ST SUITE 106
FRESNO CA
93720-2955
US

IV. Provider business mailing address

7011 N HOWARD ST SUITE 106
FRESNO CA
93720-2955
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-6600
  • Fax: 559-431-6106
Mailing address:
  • Phone: 559-431-6600
  • Fax: 559-431-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG66119
License Number StateCA

VIII. Authorized Official

Name: DR. RAYMOND CANUTO MIRANDA
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 559-431-6600