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General NPI Number Information
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NPI Number | 1336956275
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY EMERGENCY MEDICINE
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 465 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3320
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Country | US
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Telephone | 559-784-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 W GOSHEN AVE PMB 325
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City | VISALIA
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State | CA
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Zip | 93291-8619
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Country | US
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Telephone | 559-802-5596
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HARJOTH MALLI
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Credential | MD
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Telephone | 415-450-5921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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