Healthcare Provider Details

I. General information

NPI: 1699830984
Provider Name (Legal Business Name): VALLEY HEALTH TEAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 S MADERA AVE
KERMAN CA
93630-1743
US

IV. Provider business mailing address

PO BOX 737
SAN JOAQUIN CA
93660-0737
US

V. Phone/Fax

Practice location:
  • Phone: 559-364-2980
  • Fax: 559-326-5323
Mailing address:
  • Phone: 559-693-2462
  • Fax: 559-692-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number040000522
License Number StateCA

VIII. Authorized Official

Name: MRS. SOYLA R. GRIFFIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: C.P.A.
Phone: 559-693-2462