Healthcare Provider Details

I. General information

NPI: 1285906941
Provider Name (Legal Business Name): CENTRAL VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
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:
Mailing address:
  • Phone: 559-431-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG66119
License Number StateCA

VIII. Authorized Official

Name: DR. RAYMOND CANUTO MIRANDA
Title or Position: PRESIDENT
Credential: MD
Phone: 559-431-6600