Healthcare Provider Details

I. General information

NPI: 1063691467
Provider Name (Legal Business Name): SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC. - DEPT OF NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL MB20
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL MB20
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6215
  • Fax: 559-353-6222
Mailing address:
  • Phone: 559-353-6215
  • Fax: 559-353-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateCA

VIII. Authorized Official

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