Healthcare Provider Details

I. General information

NPI: 1508166190
Provider Name (Legal Business Name): SOUTH VALLEY VASCULAR ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S. AKERS SUITE 120
VISALIA CA
93277-5121
US

IV. Provider business mailing address

PO BOX 7030
VISALIA CA
93290-7030
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-4118
  • Fax: 559-625-6004
Mailing address:
  • Phone: 559-625-4118
  • Fax: 559-625-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW P CAMPBELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-625-4118