Healthcare Provider Details

I. General information

NPI: 1639445836
Provider Name (Legal Business Name): SPECIALTY MEDICAL GROUP - DEPT OF PERINATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL MAILSTOP FC25
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL MAILSTOP FC25
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6700
  • Fax: 559-353-6710
Mailing address:
  • Phone: 559-353-6700
  • Fax: 559-353-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DEVONNA KAJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-353-5700