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General NPI Number Information
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NPI Number | 1194935296
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY ORTHOPAEDIC SPECIALISTS MEDICAL GROUP, INC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1901 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95204-6005
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Country | US
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Telephone | 209-948-1641
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Fax | 209-948-0660
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Provider Business Mailing Address
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Address Line | 1901 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95204-6005
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Country | US
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Telephone | 209-948-1641
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Fax | 209-948-0660
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JANA VALDEZ
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Credential |
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Telephone | 209-948-1641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number |
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License Number State | CA
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