=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154704914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL VALLEY MOBILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2015
-----------------------------------------------------
Last Update Date | 06/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6084 JOSIE ST
-----------------------------------------------------
City | ATWATER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95301-9105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-648-1994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 BUSINESS PARK WAY
-----------------------------------------------------
City | ATWATER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95301-9483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-676-2791
-----------------------------------------------------
Fax | 209-812-4315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | ENRIQUE TALAMANTES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-648-1994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 102-757630
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------