Healthcare Provider Details

I. General information

NPI: 1720457088
Provider Name (Legal Business Name): CGCA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S 6TH ST
COTTAGE GROVE OR
97424-2016
US

IV. Provider business mailing address

35 S 6TH ST
COTTAGE GROVE OR
97424-2016
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-7530
  • Fax: 541-203-7509
Mailing address:
  • Phone: 541-357-7530
  • Fax: 541-203-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DARBY VALLEY
Title or Position: ACUPUNCTURIST
Credential: L.AC., DAOM
Phone: 541-357-7530