=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376719872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY NEUROLOGY MEDICAL CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 05/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1860 S CENTRAL ST SUITE B
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93277-4496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-738-1828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1860 S CENTRAL AVE STE B
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93277-4497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-738-1828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. BASSAM IBRAHIM ALZAGATITI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 559-738-1828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A56366
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------