Healthcare Provider Details

I. General information

NPI: 1366829640
Provider Name (Legal Business Name): CENTRAL VALLEY CRITICAL CARE MEDICINE - A PROFESSIONAL CORPORAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MALL DR
HANFORD CA
93230-5786
US

IV. Provider business mailing address

5211 W GOSHEN AVE PMB 326
VISALIA CA
93291-8619
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-9000
  • Fax:
Mailing address:
  • Phone: 559-802-5596
  • Fax: 559-802-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC50351
License Number StateCA

VIII. Authorized Official

Name: HARJOTH SINGH MALLI
Title or Position: CO-OWNER/CEO
Credential:
Phone: 559-732-0762