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General NPI Number Information
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NPI Number | 1023062171
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Entity Type | Organization
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Legal Business Name | GRASS VALLEY CARDIOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 150 CATHERINE LANE D
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City | GRASS VALLEY
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State | CA
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Zip | 95945
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Country | US
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Telephone | 530-477-8358
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Fax | 530-477-2015
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Provider Business Mailing Address
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Address Line | 150 CATHERINE LN SUITE D
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5719
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Country | US
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Telephone | 530-477-8358
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Fax | 530-477-2015
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. NANCY L BENTON
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Credential |
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Telephone | 530-477-7265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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