Healthcare Provider Details

I. General information

NPI: 1396967295
Provider Name (Legal Business Name): KAWEAH NEUROLOGICAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SANTA FE AVE
VISALIA CA
93292-2940
US

IV. Provider business mailing address

501 S SANTA FE AVE
VISALIA CA
93292-2940
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-1054
  • Fax: 559-625-1385
Mailing address:
  • Phone: 559-625-1054
  • Fax: 559-625-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00G515050
License Number StateCA

VIII. Authorized Official

Name: MISS LISA ALVA
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-625-1054