Healthcare Provider Details

I. General information

NPI: 1437555265
Provider Name (Legal Business Name): VALLEY CHILDREN'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE SUITE 550
MODESTO CA
95350-4500
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL MAILSTOP SC61
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5010
  • Fax:
Mailing address:
  • Phone: 559-353-5010
  • Fax: 559-353-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL GOLDRING
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 559-353-5010