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General NPI Number Information
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NPI Number | 1144572553
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY CARDIOVASCULAR ASSOCIATES INC
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 1148 NORMAN DR SUITE 2
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City | MANTECA
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State | CA
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Zip | 95336-5961
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Country | US
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Telephone | 209-942-1005
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Fax | 209-239-7842
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Provider Business Mailing Address
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Address Line | PO BOX 7065
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City | STOCKTON
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State | CA
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Zip | 95267-0065
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Country | US
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Telephone | 209-942-1005
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Fax | 209-239-7842
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Authorized Official
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Title or Position | OWNER
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Name | DR. VENKATA EMANI
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Credential | MD
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Telephone | 209-465-0123
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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 | A80313
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License Number State | CA
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