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General NPI Number Information
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NPI Number | 1790122083
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY MEDICAL PROVIDERS
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1111 E SPRUCE AVE
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City | FRESNO
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State | CA
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Zip | 93720-3330
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Country | US
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Telephone | 559-450-5792
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 E HERNDON AVE MS# 940
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City | FRESNO
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State | CA
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Zip | 93720-3309
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Country | US
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Telephone | 559-450-5792
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | KIMBERLY CRUZ
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Credential |
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Telephone | 559-581-8769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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