=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790987139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY MEDICAL GROUP OF KERN COUNTY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 WHITE LN
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-6279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-836-4000
-----------------------------------------------------
Fax | 661-847-4097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11510
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93389-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-836-4000
-----------------------------------------------------
Fax | 661-847-4097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CARLOS A ALVAREZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 661-836-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | A429860
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------