Healthcare Provider Details

I. General information

NPI: 1043376577
Provider Name (Legal Business Name): VALLEY HEALTH TEAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21890 COLORADO AVE
SAN JOAQUIN CA
93660-0737
US

IV. Provider business mailing address

PO BOX 737
SAN JOAQUIN CA
93660-0737
US

V. Phone/Fax

Practice location:
  • Phone: 559-693-2462
  • Fax: 559-693-4382
Mailing address:
  • Phone: 559-693-2462
  • Fax: 559-693-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number040000522
License Number StateCA

VIII. Authorized Official

Name: MRS. SOYLA R. GRIFFIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: C.P.A.
Phone: 559-693-2462