Healthcare Provider Details

I. General information

NPI: 1043407687
Provider Name (Legal Business Name): SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC - DEPT OF ENDOCRINOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6600
  • Fax: 559-353-6612
Mailing address:
  • Phone: 559-353-6600
  • Fax: 559-353-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: RALPH P. DIAZ
Title or Position: PRESIDENT AND MEDICAL DIRECTOR
Credential: MD
Phone: 559-353-5700