Healthcare Provider Details

I. General information

NPI: 1194935296
Provider Name (Legal Business Name): CENTRAL VALLEY ORTHOPAEDIC SPECIALISTS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N CALIFORNIA ST
STOCKTON CA
95204-6005
US

IV. Provider business mailing address

1901 N CALIFORNIA ST
STOCKTON CA
95204-6005
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-1641
  • Fax: 209-948-0660
Mailing address:
  • Phone: 209-948-1641
  • Fax: 209-948-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. JANA VALDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-948-1641