Healthcare Provider Details

I. General information

NPI: 1396921482
Provider Name (Legal Business Name): VALLEY CHILDREN'S MEDICAL CENTER, A.M.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N 1ST ST STE 102
FRESNO CA
93726-0973
US

IV. Provider business mailing address

4646 N 1ST ST STE 102
FRESNO CA
93726-0973
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-4646
  • Fax: 559-227-4646
Mailing address:
  • Phone: 559-226-4646
  • Fax: 559-227-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115072
License Number StateCA

VIII. Authorized Official

Name: NAVEEN JINDAL
Title or Position: PRESIDENT
Credential:
Phone: 559-226-4646