Healthcare Provider Details

I. General information

NPI: 1962750224
Provider Name (Legal Business Name): CENTRAL VALLEY CARDIOVASCULAR MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 COLORADO AVE
TURLOCK CA
95380-2711
US

IV. Provider business mailing address

PO BOX 4978
MODESTO CA
95352-4978
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-8030
  • Fax: 209-668-8031
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number40507
License Number StateCA

VIII. Authorized Official

Name: DR. REZA NAZARI
Title or Position: CEO
Credential: M.D.
Phone: 209-602-6684