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General NPI Number Information
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NPI Number | 1548487580
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Entity Type | Organization
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Legal Business Name | SUCCESS VALLEY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 53 E CLEVELAND AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3748
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Country | US
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Telephone | 559-781-6323
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Fax | 559-781-7290
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Provider Business Mailing Address
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Address Line | 53 E CLEVELAND AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3748
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Country | US
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Telephone | 559-781-6323
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Fax | 559-781-7290
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HUGO RENE ESCOBAR
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Credential | M.D.
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Telephone | 559-781-6323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | A21821
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License Number State | CA
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