Healthcare Provider Details

I. General information

NPI: 1174666168
Provider Name (Legal Business Name): VALLEY INDUSTRIAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E TERRACE AVE
TULARE CA
93274-2175
US

IV. Provider business mailing address

755 E TERRACE AVE
TULARE CA
93274-2175
US

V. Phone/Fax

Practice location:
  • Phone: 559-685-8800
  • Fax: 559-685-9366
Mailing address:
  • Phone: 559-685-8800
  • Fax: 559-685-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberG21545
License Number StateCA

VIII. Authorized Official

Name: MR. R. STEVEN ALCOCER
Title or Position: CLINICAL DIRECTOR-OWNER
Credential: PA-C
Phone: 559-685-8800