Healthcare Provider Details

I. General information

NPI: 1568427904
Provider Name (Legal Business Name): VALLEY METABOLIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N THESTA AVE STE 207
FRESNO CA
93710
US

IV. Provider business mailing address

11100 NE 8TH ST STE 500
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 559-449-2640
  • Fax: 559-432-7020
Mailing address:
  • Phone: 425-635-4365
  • Fax: 425-637-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1DTF
License Number State

VIII. Authorized Official

Name: CLAY R STEVENS
Title or Position: MEMBER MANAGER
Credential:
Phone: 949-631-2221