Healthcare Provider Details

I. General information

NPI: 1881830040
Provider Name (Legal Business Name): VALLEY INTERVENTIONAL PAIN MEDICAL GRP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE #445
MODESTO CA
95350
US

IV. Provider business mailing address

1524 MCHENRY AVE. #445
MODESTO CA
95350
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-1693
  • Fax: 209-571-0326
Mailing address:
  • Phone: 209-571-1693
  • Fax: 209-571-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D1086032
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES E BARNETT
Title or Position: OWNER
Credential: MD
Phone: 209-571-1693